Healthcare Provider Details

I. General information

NPI: 1285538330
Provider Name (Legal Business Name): GARD THERAPEUTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W BROAD ST STE 20
STATESVILLE NC
28677-5258
US

IV. Provider business mailing address

497 CRAWFORD RD
STATESVILLE NC
28625-8545
US

V. Phone/Fax

Practice location:
  • Phone: 980-453-0090
  • Fax: 704-272-3056
Mailing address:
  • Phone: 980-453-0090
  • Fax: 704-272-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIEL COOKE
Title or Position: OWNER/THERAPIST
Credential: LCMHC-A, LCAS-A
Phone: 704-380-3419