Individual
JENNIFER COOKE STAAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4608 CEDAR AVE, SUITE 106, WILMINGTON, NC 28403-4419
(910) 547-3093
Mailing address
4608 CEDAR AVENUE, SUITE 106, WILMINGTON, NC 28403
(910) 547-3093
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2505
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046K0
BLUE CROSS BLUE SHIELD
NC
01
—
240133
COMPSYCH
NC
05
—
6000577
—
NC
01
—
D6590
MEDCOST
NC
01
—
NCMC034119
VALUE OPTIONS
NY
Enumeration date
12/29/2005
Last updated
10/30/2007
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