Provider Demographics
NPI:1235591942
Name:COOK, DIANE (EDS, LPC, BC-TMH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:EDS, LPC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 RODGERS RD
Mailing Address - Street 2:
Mailing Address - City:EIGHT MILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-9136
Mailing Address - Country:US
Mailing Address - Phone:251-656-8036
Mailing Address - Fax:205-839-8330
Practice Address - Street 1:820 S UNIVERSITY BLVD STE 4F
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7862
Practice Address - Country:US
Practice Address - Phone:251-281-8562
Practice Address - Fax:205-839-8330
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3227101Y00000X
WYLPC 1562101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor