Provider Demographics
NPI:1174312839
Name:WASHINGTONCOOK, STEPHANIE DANYEL
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DANYEL
Last Name:WASHINGTONCOOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 N 107TH DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2625
Mailing Address - Country:US
Mailing Address - Phone:616-337-6573
Mailing Address - Fax:
Practice Address - Street 1:908 W CHANDLER BLVD # A
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2548
Practice Address - Country:US
Practice Address - Phone:480-764-2863
Practice Address - Fax:480-907-1561
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAAC-15561101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)