MEDICARE: SHAWNA RENE COOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	20403A	NC

General Provider Information

NPI Number	:	1386588309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA RENE COOK

Provider Business Mailing Address
First Line	:	15119 SCOTER ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-2123
Country	:	US
Telephone Number	:	619-871-8594
Fax Number	:

Provider Business Practice Location Address
First Line	:	15119 SCOTER ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-2123
Country	:	US
Telephone Number	:	619-871-8594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2026
Last Update Date	:	04/18/2026

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Directions to “ SHAWNA RENE COOK ” Practice Location

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