Provider Demographics
NPI:1902614118
Name:COOK, SARA RACHEL (APC, MS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:RACHEL
Last Name:COOK
Suffix:
Gender:F
Credentials:APC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 BALLPARK LN APT 1207
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2183
Mailing Address - Country:US
Mailing Address - Phone:706-764-6998
Mailing Address - Fax:
Practice Address - Street 1:1244 CLAIRMONT RD STE 102
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1250
Practice Address - Country:US
Practice Address - Phone:770-750-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health