Provider Demographics
NPI:1639422827
Name:COOK, CATHERINE E (LPC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:E
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:E
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3737 SEMINARY RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-5202
Mailing Address - Country:US
Mailing Address - Phone:703-746-3444
Mailing Address - Fax:703-746-3464
Practice Address - Street 1:720 N SAINT ASAPH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1912
Practice Address - Country:US
Practice Address - Phone:703-746-3444
Practice Address - Fax:703-746-3464
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1447279658Medicaid