Basic Information
| Provider Information | |||||||||
| NPI: | 1720223464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COOK-WION | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | LICDC-CS, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 WALNUT ST | ||||||||
| Address2: | GREENVILLE | ||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453311944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375486842 | ||||||||
| FaxNumber: | 9375488938 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 WALNUT ST | ||||||||
| Address2: | GREENVILLE | ||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453311944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375486842 | ||||||||
| FaxNumber: | 9375488938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2008 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 933501 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 0215079 | 05 | OH | MEDICAID |