Provider Demographics
NPI:1073646741
Name:COOK, TANJALESA (LCSW)
Entity type:Individual
Prefix:
First Name:TANJALESA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TANJALESA
Other - Middle Name:COOK
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:108 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-7851
Mailing Address - Country:US
Mailing Address - Phone:828-508-8811
Mailing Address - Fax:
Practice Address - Street 1:108 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-7851
Practice Address - Country:US
Practice Address - Phone:828-508-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0053781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC146UAOtherBCBSNC
NC6106425Medicaid
NC6106425Medicaid