Provider Demographics
NPI:1174090252
Name:COLE, DAKOTAH ANTONY (LCSW)
Entity type:Individual
Prefix:
First Name:DAKOTAH
Middle Name:ANTONY
Last Name:COLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 N GARNET CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-8001
Mailing Address - Country:US
Mailing Address - Phone:208-740-0544
Mailing Address - Fax:
Practice Address - Street 1:2121 N GARNET CREEK AVE
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-8001
Practice Address - Country:US
Practice Address - Phone:208-740-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLICSW453411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical