Provider Demographics
NPI:1841714268
Name:COOK, LORI ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
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 1:300 KENTON DRIVE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311
Mailing Address - Country:US
Mailing Address - Phone:304-347-9818
Mailing Address - Fax:304-347-9820
Practice Address - Street 1:3871 ROBERT C BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-929-4130
Practice Address - Fax:304-929-4134
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5200000001Medicaid