Provider Demographics
NPI:1073352969
Name:COOK, WANDA LOUANNE (LCMHCA)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:LOUANNE
Last Name:COOK
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 SHADY GROVE LN
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-7424
Mailing Address - Country:US
Mailing Address - Phone:336-408-5330
Mailing Address - Fax:
Practice Address - Street 1:1255 CREEKSHIRE WAY STE 270
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3061
Practice Address - Country:US
Practice Address - Phone:336-701-3111
Practice Address - Fax:888-757-4153
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health