Provider Information for 1629588603
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CHARNELLE COOK LPC
Sex: Female
NPI: 1629588603
Last Updated: 2021-04-13
Certification Date: 2021-04-13
Certification Date: 2021-04-13
Details
Name | Value | ||||||||
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NPI | 1629588603 | ||||||||
Enumeration Date | 2017-10-04 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | PO BOX 5111 PORTSMOUTH, VA 23703-1111 United States Phone: 757-550-1965 | Fax: | ||||||||
Primary Practice Address | 1015 EDEN WAY N STE B CHESAPEAKE, VA 23320-2787 United States Phone: 571-215-6477 | Fax:571-215-6477 | ||||||||
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