Provider Demographics
NPI:1568500858
Name:COOKE, AMY NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:NICOLE
Last Name:COOKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:NICOLE
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:616 PARK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1922
Mailing Address - Country:US
Mailing Address - Phone:276-679-1045
Mailing Address - Fax:276-679-1047
Practice Address - Street 1:616 PARK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1922
Practice Address - Country:US
Practice Address - Phone:276-679-1045
Practice Address - Fax:276-679-1045
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040086921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical