Provider Demographics
NPI:1932817442
Name:COOK, CHRISTINE LOVE (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOVE
Last Name:COOK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 W SANTA CRUZ ST STE A125
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2246
Mailing Address - Country:US
Mailing Address - Phone:704-458-8484
Mailing Address - Fax:
Practice Address - Street 1:173 W SANTA CRUZ ST STE A125
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2246
Practice Address - Country:US
Practice Address - Phone:704-458-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional