Healthcare Provider Details

I. General information

NPI: 1487156881
Provider Name (Legal Business Name): STEPHENIE AUGUST COOK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 ISLAND AVE
PHILADELPHIA PA
19153-3013
US

IV. Provider business mailing address

148 PIERCE ST
PHILADELPHIA PA
19148-1910
US

V. Phone/Fax

Practice location:
  • Phone: 267-713-4100
  • Fax:
Mailing address:
  • Phone: 267-713-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC010301
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: