Provider Demographics
NPI:1487385209
Name:COLE, CHRISTIAN B
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:B
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-1233
Mailing Address - Country:US
Mailing Address - Phone:209-327-7538
Mailing Address - Fax:
Practice Address - Street 1:715 N SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-1233
Practice Address - Country:US
Practice Address - Phone:209-426-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)