Healthcare Provider Details

I. General information

NPI: 1497188999
Provider Name (Legal Business Name): MICHELLE P COOKE PSY.D, LADC I, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4390 BELLE OAKS DR
NORTH CHARLESTON SC
29405
US

IV. Provider business mailing address

1211 DINGLE RD
MOUNT PLEASANT SC
29466-9386
US

V. Phone/Fax

Practice location:
  • Phone: 843-414-2670
  • Fax:
Mailing address:
  • Phone: 978-500-2776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number10590
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number1470
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: