Provider Demographics
NPI:1427033182
Name:COOK, ANGELYNE W (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELYNE
Middle Name:W
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 1:1812 DIXIE YOUTH DR
Mailing Address - Street 2:
Mailing Address - City:CHATOM
Mailing Address - State:AL
Mailing Address - Zip Code:36518
Mailing Address - Country:US
Mailing Address - Phone:251-847-3058
Mailing Address - Fax:
Practice Address - Street 1:1812 DIXIE YOUTH DR
Practice Address - Street 2:
Practice Address - City:CHATOM
Practice Address - State:AL
Practice Address - Zip Code:36518
Practice Address - Country:US
Practice Address - Phone:251-847-3058
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1052C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN
PENDINGMedicare ID - Type Unspecified