Healthcare Provider Details

I. General information

NPI: 1649602335
Provider Name (Legal Business Name): MARIA ISAAC COOK LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4917 PIEDMONT PKWY STE 104
JAMESTOWN NC
27282-7536
US

IV. Provider business mailing address

10 POWELL CT
BROWNS SUMMIT NC
27214-9801
US

V. Phone/Fax

Practice location:
  • Phone: 336-493-5600
  • Fax:
Mailing address:
  • Phone: 336-457-4934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022100
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: