Provider Demographics
NPI:1669013165
Name:COOK, KRISTINA (MS; LPCC; NCC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MS; LPCC; NCC
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 5722
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95696-5722
Mailing Address - Country:US
Mailing Address - Phone:530-966-8144
Mailing Address - Fax:
Practice Address - Street 1:1460 MARIA LN STE 300
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5314
Practice Address - Country:US
Practice Address - Phone:530-966-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-05
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC12719101Y00000X, 101YM0800X, 101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health