Provider Demographics
NPI:1699968834
Name:COOK, MOLLY FAITH (LCSW, LISAC)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:FAITH
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-3393
Mailing Address - Country:US
Mailing Address - Phone:928-231-9635
Mailing Address - Fax:
Practice Address - Street 1:15331 W BELL RD
Practice Address - Street 2:STE 219
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4102
Practice Address - Country:US
Practice Address - Phone:928-231-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11431101YA0400X
AZ11813104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)