Provider Demographics
NPI:1205567344
Name:COOK, EMERSON WELLS (LCSW)
Entity type:Individual
Prefix:MR
First Name:EMERSON
Middle Name:WELLS
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 1:2050 NEWNAN CROSSING BLVD E APT 5201
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2362
Mailing Address - Country:US
Mailing Address - Phone:251-895-4814
Mailing Address - Fax:
Practice Address - Street 1:2050 NEWNAN CROSSING BLVD E APT 5201
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2362
Practice Address - Country:US
Practice Address - Phone:251-895-4814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0079931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical