Provider Demographics
NPI:1740355353
Name:COOK, KELLI J (LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLI
Middle Name:J
Last Name:COOK
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 1:435 HOLLYBROOK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2436
Mailing Address - Country:US
Mailing Address - Phone:804-651-6589
Mailing Address - Fax:804-236-0710
Practice Address - Street 1:435 HOLLYBROOK RIDGE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2436
Practice Address - Country:US
Practice Address - Phone:804-651-6589
Practice Address - Fax:804-236-0710
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical