Individual
STACIE CHISOLM COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
560 MCKOY ST, DECATUR, GA 30030-4950
(404) 438-2347
Mailing address
560 MCKOY ST, DECATUR, GA 30030-4950
(404) 438-2347
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
3508
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
633486737A
—
GA
Enumeration date
01/10/2007
Last updated
02/06/2012
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