Provider Demographics
NPI:1124601455
Name:COOKE, STEPHANIE CHEYENNE (MA, LMFTA)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:CHEYENNE
Last Name:COOKE
Suffix:
Gender:F
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 W 1ST ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3642
Mailing Address - Country:US
Mailing Address - Phone:336-914-3038
Mailing Address - Fax:
Practice Address - Street 1:1022 W 1ST ST STE 203
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3642
Practice Address - Country:US
Practice Address - Phone:336-914-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12234A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty