Provider Demographics
NPI:1235188491
Name:COOK, KIMBERLY LYNN (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:COOK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1101 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-3101
Mailing Address - Country:US
Mailing Address - Phone:423-486-0774
Mailing Address - Fax:
Practice Address - Street 1:1312 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3918
Practice Address - Country:US
Practice Address - Phone:877-358-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2391041C0700X
NCC0127121041C0700X
IA1202201041C0700X
TN67571041C0700X
FL681041C0700X
VA09040097571041C0700X
GACSW0073261041C0700X
MD116091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD447380900Medicaid
VA215422ZDVMedicaid
TNQ048467Medicaid
GA003213184CMedicaid
TNQ048467Medicaid