Provider Demographics
NPI:1427815521
Name:COCHRAN-NORFOLK, DESIREE NICOLE (CCS, CMAC, CAC II)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:NICOLE
Last Name:COCHRAN-NORFOLK
Suffix:
Gender:F
Credentials:CCS, CMAC, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 NAPPA TRL
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4141
Mailing Address - Country:US
Mailing Address - Phone:678-866-5826
Mailing Address - Fax:
Practice Address - Street 1:2956 NAPPA TRL
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-4141
Practice Address - Country:US
Practice Address - Phone:678-866-5826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1036101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)