Provider Demographics
NPI:1790842292
Name:GAFFIGAN, COOLEY LAWRENCE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:COOLEY
Middle Name:LAWRENCE
Last Name:GAFFIGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 E FRANKLIN ST
Mailing Address - Street 2:SUITE 900B
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5861
Mailing Address - Country:US
Mailing Address - Phone:919-360-7583
Mailing Address - Fax:
Practice Address - Street 1:1829 E FRANKLIN ST
Practice Address - Street 2:SUITE 900B
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5861
Practice Address - Country:US
Practice Address - Phone:919-360-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0040761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002606Medicaid
NC028168OtherVALUEOPTIONS PROV. # NCMC