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General NPI Number Information
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NPI Number | 1497188999
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Entity Type | Individual
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Provider Name | MICHELLE P COOKE PSY.D, LADC I, CADC
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Gender | Female
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4390 BELLE OAKS DR
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405
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Country | US
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Telephone | 843-414-2670
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 DINGLE RD
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City | MOUNT PLEASANT
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State | SC
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Zip | 29466-9386
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Country | US
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Telephone | 978-500-2776
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 10590
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 1470
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License Number State | SC
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