Individual
AGNES G COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3491 KURTZ ST STE 150, SAN DIEGO, CA 92110-4430
(619) 320-2404
Mailing address
6884 HYDE PARK DR UNIT A, SAN DIEGO, CA 92119-2235
(619) 869-3163
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
129662
CA
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
373781000
—
CA
Enumeration date
03/02/2018
Last updated
06/16/2025
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