Provider Demographics
NPI:1548584493
Name:COOKE, STACIE DANEILLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:DANEILLE
Last Name:COOKE
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 1:16581 US HIGHWAY 17 N STE 600
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-7451
Mailing Address - Country:US
Mailing Address - Phone:910-270-9995
Mailing Address - Fax:910-270-9905
Practice Address - Street 1:16581 US HIGHWAY 17 N STE 600
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-7451
Practice Address - Country:US
Practice Address - Phone:910-270-9995
Practice Address - Fax:910-270-9905
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical