Provider Demographics
NPI:1285355792
Name:COOK-GRAHAM, ALEXXIS S
Entity type:Individual
Prefix:
First Name:ALEXXIS
Middle Name:S
Last Name:COOK-GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1882 S NEW HOPE RD UNIT 550100
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28055-6504
Mailing Address - Country:US
Mailing Address - Phone:704-728-0797
Mailing Address - Fax:
Practice Address - Street 1:7710 WATERFORD SQUARE DR APT 1133
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8643
Practice Address - Country:US
Practice Address - Phone:704-728-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8158101YM0800X
NCA17564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health