Healthcare Provider Details

I. General information

NPI: 1033932579
Provider Name (Legal Business Name): ADRIANA COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 N LIMESTONE ST
SPRINGFIELD OH
45503-2648
US

IV. Provider business mailing address

114 N WOODWARD AVE
DAYTON OH
45417-2431
US

V. Phone/Fax

Practice location:
  • Phone: 937-910-6220
  • Fax: 800-480-7578
Mailing address:
  • Phone: 832-515-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.196467
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: