Provider Demographics
NPI:1629588603
Name:COOK, CHARNELLE (LPC)
Entity Type:Individual
Prefix:
First Name:CHARNELLE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5111
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-1111
Mailing Address - Country:US
Mailing Address - Phone:757-550-1965
Mailing Address - Fax:
Practice Address - Street 1:1015 EDEN WAY N STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2787
Practice Address - Country:US
Practice Address - Phone:571-215-6477
Practice Address - Fax:571-215-6477
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional