Healthcare Provider Details

I. General information

NPI: 1114636164
Provider Name (Legal Business Name): DENISHA RENEE COOK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 HOSPITAL AVE
MARION VA
24354-3157
US

IV. Provider business mailing address

770 W RIDGE RD
WYTHEVILLE VA
24382-1187
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-8185
  • Fax: 276-783-5030
Mailing address:
  • Phone: 276-223-3200
  • Fax: 276-223-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014532
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: