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General NPI Number Information
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NPI Number | 1295466555
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Entity Type | Individual
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Provider Name | TRACY COOK-BREWTON LMHC - ASSOCIATE
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Gender | Female
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 06/17/2022
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Provider Practice Location Address
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Address Line | 3020 PROSPERITY CHURCH RD STE I-945
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City | CHARLOTTE
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State | NC
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Zip | 28269-7197
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Country | US
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Telephone | 980-533-1276
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Fax |
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Provider Business Mailing Address
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Address Line | 3319 DEERWOOD DR
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City | GASTONIA
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State | NC
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Zip | 28054-1932
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Country | US
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Telephone | 704-915-5196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 1221074
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A17707
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License Number State | NC
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