Provider Demographics
NPI:1740853001
Name:COOK, JEANETTE GUANITA (LPC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:GUANITA
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 VIEWPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-7103
Mailing Address - Country:US
Mailing Address - Phone:404-769-2234
Mailing Address - Fax:
Practice Address - Street 1:1944 BRANNAN RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4310
Practice Address - Country:US
Practice Address - Phone:678-289-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012225101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional