Provider Demographics
NPI:1255145322
Name:COLE, OLIVIA GRACE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GRACE
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CHAMPLAIN ST
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-3946
Mailing Address - Country:US
Mailing Address - Phone:774-283-3002
Mailing Address - Fax:
Practice Address - Street 1:26 PARKRIDGE RD
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01835-8514
Practice Address - Country:US
Practice Address - Phone:978-222-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health