Provider Demographics
NPI:1659430858
Name:COOK, LYNDA MANN (LCAS)
Entity type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:MANN
Last Name:COOK
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:WENTWORTH
Mailing Address - State:NC
Mailing Address - Zip Code:27375
Mailing Address - Country:US
Mailing Address - Phone:336-342-8316
Mailing Address - Fax:336-342-8352
Practice Address - Street 1:405 NC 65
Practice Address - Street 2:
Practice Address - City:WENTWORTH
Practice Address - State:NC
Practice Address - Zip Code:27375-0355
Practice Address - Country:US
Practice Address - Phone:336-342-8316
Practice Address - Fax:336-342-8352
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111832Medicaid