Provider Demographics
NPI:1407217169
Name:COOK, ASHLEY NOELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NOELLE
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 SW BETHANY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1964
Mailing Address - Country:US
Mailing Address - Phone:772-301-1354
Mailing Address - Fax:772-281-2706
Practice Address - Street 1:451 SW BETHANY DR STE 103
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1964
Practice Address - Country:US
Practice Address - Phone:772-301-1354
Practice Address - Fax:772-281-2706
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 133491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical