Provider Demographics
NPI:1225483233
Name:COOK, KRISTY-ANN (LGSW)
Entity Type:Individual
Prefix:
First Name:KRISTY-ANN
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SENTRY LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2973
Mailing Address - Country:US
Mailing Address - Phone:845-242-1084
Mailing Address - Fax:
Practice Address - Street 1:208 SENTRY LN
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2973
Practice Address - Country:US
Practice Address - Phone:845-242-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00943769101YM0800X
MD20425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health