Healthcare Provider Details

I. General information

NPI: 1942143839
Provider Name (Legal Business Name): HOLLY COOKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WINDERMERE DR
CULPEPER VA
22701-1213
US

IV. Provider business mailing address

30295 ELEYS FORD RD
RICHARDSVILLE VA
22736-1925
US

V. Phone/Fax

Practice location:
  • Phone: 972-951-4531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004191
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: