Provider Demographics
NPI:1144869421
Name:COOKE, MANDI DANIELLE (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:DANIELLE
Last Name:COOKE
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:MANDI
Other - Middle Name:DANIELLE
Other - Last Name:CAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4730 WOODSWAY LN
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-8513
Mailing Address - Country:US
Mailing Address - Phone:252-315-0676
Mailing Address - Fax:
Practice Address - Street 1:4730 WOODSWAY LN
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-8513
Practice Address - Country:US
Practice Address - Phone:252-315-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical