Healthcare Provider Details

I. General information

NPI: 1295466555
Provider Name (Legal Business Name): TRACY COOK-BREWTON LMHC - ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2949 AUDREY DR
GASTONIA NC
28054-7269
US

IV. Provider business mailing address

3319 DEERWOOD DR
GASTONIA NC
28054-1932
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-4003
  • Fax: 704-396-6516
Mailing address:
  • Phone: 704-915-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1221074
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17707
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: