Provider Demographics
NPI:1659908853
Name:COOLEY, ANDRENA CAROLINE (CSAC-I, NCCPSS)
Entity Type:Individual
Prefix:
First Name:ANDRENA
Middle Name:CAROLINE
Last Name:COOLEY
Suffix:
Gender:F
Credentials:CSAC-I, NCCPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-4315
Mailing Address - Country:US
Mailing Address - Phone:910-352-8750
Mailing Address - Fax:
Practice Address - Street 1:3420 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4118
Practice Address - Country:US
Practice Address - Phone:910-725-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-25884101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)