Provider Demographics
NPI:1548513963
Name:COLE-STRAUB, CASSIN (PSYD)
Entity type:Individual
Prefix:
First Name:CASSIN
Middle Name:
Last Name:COLE-STRAUB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 HERRINGTON RD
Mailing Address - Street 2:BLDG. 2
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7987
Mailing Address - Country:US
Mailing Address - Phone:507-722-2402
Mailing Address - Fax:770-962-1886
Practice Address - Street 1:1805 HERRINGTON RD
Practice Address - Street 2:BLDG. 2
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7987
Practice Address - Country:US
Practice Address - Phone:507-722-2402
Practice Address - Fax:770-962-1886
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003641103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist