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NPI Code Detail

MEDICARE: GRACIE COOK

MEDICARE: GRACIE COOK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1407699077
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACIE COOK
Provider Business Mailing Address
First Line : 3015 MARKET ST
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-0724
Country : US
Telephone Number : 910-554-3081
Fax Number :
Provider Business Practice Location Address
First Line : 3015 MARKET ST
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-0724
Country : US
Telephone Number : 910-554-3081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2024
Last Update Date : 06/05/2026

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Directions to “ GRACIE COOK ” Practice Location

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