Provider Demographics
NPI:1023487519
Name:COOK, TABITHA NICHOLE (LCSW-A)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:NICHOLE
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8894 OLDENBURG DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124-8543
Mailing Address - Country:US
Mailing Address - Phone:704-652-2544
Mailing Address - Fax:
Practice Address - Street 1:8894 OLDENBURG DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:NC
Practice Address - Zip Code:28124-8543
Practice Address - Country:US
Practice Address - Phone:704-652-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0097801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical