Provider Demographics
NPI:1710198445
Name:COOK, CHRISTIE ROSE (LICSW, ACSW, DCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:ROSE
Last Name:COOK
Suffix:
Gender:F
Credentials:LICSW, ACSW, DCSW
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 711
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0711
Mailing Address - Country:US
Mailing Address - Phone:304-335-4739
Mailing Address - Fax:
Practice Address - Street 1:226 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3814
Practice Address - Country:US
Practice Address - Phone:304-636-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical