Provider Demographics
NPI:1265900070
Name:KOOKEN, KEELEY DANIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:DANIELLE
Last Name:KOOKEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 CEDAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-4617
Mailing Address - Country:US
Mailing Address - Phone:404-663-5758
Mailing Address - Fax:
Practice Address - Street 1:511 CEDAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30656-4617
Practice Address - Country:US
Practice Address - Phone:404-663-5758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0078021041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical