Cooley, Shawandalyn Latrelle
Cooley, Shawandalyn Latrelle is an individual health care provider with primary practice located at 825 Gum Branch Rd Suite 133, Jacksonville NC 28540-6298. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Cooley, Shawandalyn Latrelle can be contacted via phone (910) 346-6726.Contact Information
Primary practice address
825 Gum Branch Rd Suite 133
Jacksonville NC 28540-6298
Phone: (910) 346-6726
Fax: (910) 346-8285
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | C004961 | North Carolina |
Profile Details
| NPI number | 1376608653 |
|---|---|
| LBN Legal business name | Cooley, Shawandalyn Latrelle |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 27th, 2006 |
| Last updated | Mar 20th, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376608653 | NPPES |
| North Carolina | MEDICAID | 8300057B |
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