Provider Demographics
NPI:1922047026
Name:COOK, GARRY D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARRY
Middle Name:D
Last Name:COOK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 HICKORY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6781
Mailing Address - Country:US
Mailing Address - Phone:336-785-2834
Mailing Address - Fax:
Practice Address - Street 1:3125 HICKORY RIDGE DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-6781
Practice Address - Country:US
Practice Address - Phone:336-785-2834
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0016671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical