Provider Demographics
NPI:1720161136
Name:COOK, TEREIA SIDDEN (LPC, LCAS, CCS)
Entity Type:Individual
Prefix:MS
First Name:TEREIA
Middle Name:SIDDEN
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3589
Mailing Address - Country:US
Mailing Address - Phone:336-786-5855
Mailing Address - Fax:
Practice Address - Street 1:107 W INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3589
Practice Address - Country:US
Practice Address - Phone:336-786-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS #470101YA0400X
NCLPC #3746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102326Medicaid