Provider Demographics
NPI:1659684330
Name:COOKE-BRANHAM, LISA MARIE (EDS, LMFT-I)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:COOKE-BRANHAM
Suffix:
Gender:F
Credentials:EDS, LMFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CLUSTERS CT STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4862
Mailing Address - Country:US
Mailing Address - Phone:803-772-7776
Mailing Address - Fax:803-772-7760
Practice Address - Street 1:9 CLUSTERS CT STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4862
Practice Address - Country:US
Practice Address - Phone:803-772-7776
Practice Address - Fax:803-772-7760
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5022106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist