Provider Demographics
NPI:1891864237
Name:COOK, RANDY (LPCC-S, LICDC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:LPCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 DELTA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-3163
Mailing Address - Country:US
Mailing Address - Phone:513-321-8790
Mailing Address - Fax:513-321-8792
Practice Address - Street 1:1026 DELTA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-3163
Practice Address - Country:US
Practice Address - Phone:513-321-8790
Practice Address - Fax:513-321-8792
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991732101YA0400X
OHE0002813101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)