Provider Demographics
NPI:1134978315
Name:COOK, CAROLYN GILLESPIE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:GILLESPIE
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 1:2805 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051-9206
Mailing Address - Country:US
Mailing Address - Phone:336-816-3085
Mailing Address - Fax:
Practice Address - Street 1:2805 DARROW RD
Practice Address - Street 2:
Practice Address - City:WALKERTOWN
Practice Address - State:NC
Practice Address - Zip Code:27051-9206
Practice Address - Country:US
Practice Address - Phone:336-816-3085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician