Provider Demographics
NPI:1982717054
Name:COOK, BETHANY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:
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 1:513 GREENWAY LANDING PL
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-2211
Mailing Address - Country:US
Mailing Address - Phone:540-890-2571
Mailing Address - Fax:
Practice Address - Street 1:3247 ELECTRIC RD STE 1A
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6448
Practice Address - Country:US
Practice Address - Phone:540-772-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040063671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical