Basic Information
| Provider Information | |||||||||
| NPI: | 1114909306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2540 WINDY HILL RD SE | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300678605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706441570 | ||||||||
| FaxNumber: | 7706441576 | ||||||||
| Practice Location | |||||||||
| Address1: | 2540 WINDY HILL RD SE | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300678605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706441570 | ||||||||
| FaxNumber: | 7706441576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 10/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW002489 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.