Provider Demographics
NPI:1942054184
Name:COOK, ELIZABETH MARIE DAWN
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MARIE DAWN
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 PHILPOTT LN
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-9501
Mailing Address - Country:US
Mailing Address - Phone:304-252-9262
Mailing Address - Fax:
Practice Address - Street 1:175 PHILPOTT LN
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-9501
Practice Address - Country:US
Practice Address - Phone:304-252-9662
Practice Address - Fax:304-254-9264
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)