Provider Demographics
NPI:1437201399
Name:COOKE, TINA MARIE (LPC, LCADC, LCMHC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:COOKE
Suffix:
Gender:F
Credentials:LPC, LCADC, LCMHC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCADC, LCMHC-S
Mailing Address - Street 1:1512 BONITO LN
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-5765
Mailing Address - Country:US
Mailing Address - Phone:973-919-6698
Mailing Address - Fax:
Practice Address - Street 1:1606 HARBOUR DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7716
Practice Address - Country:US
Practice Address - Phone:910-399-1695
Practice Address - Fax:910-207-5335
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00148000101YA0400X
NJ37PC00016200101YM0800X, 101YP2500X
NC15690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health