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General NPI Number Information
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NPI Number | 1063543528
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Entity Type | Organization
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Legal Business Name | CANDICE COOK, LLC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 236 MUSTANG TRL STE 202
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7517
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Country | US
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Telephone | 757-675-1720
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Fax | 757-306-4994
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Provider Business Mailing Address
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Address Line | 236 MUSTANG TRL STE 202
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7517
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Country | US
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Telephone | 757-675-1720
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Fax | 757-306-4994
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Authorized Official
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Title or Position | DIRECTOR
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Name | CANDICE COOK
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Credential | EDD
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Telephone | 757-675-1720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701002189
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | VA
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