Nicole M Cooley, LCSW, BCD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904016120 Issued in VA

Practice address

10301 Democracy LN Ste 301302
Fairfax, VA 22030-2545

Phone

(571) 223-7588

NPI assigned

Apr 20, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jirah Corporation

  dba Ellie Mental Health

  • Mental Health Counselor
  • Fairfax, VA
  • NPI 1649997131
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1073578969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W. PERIMETER ROAD SUITE B5-19",
            "address_2": "779 MEDICAL GROUP",
            "city": "ANDREWS AFB",
            "state": "MD",
            "postal_code": "20762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10301 DEMOCRACY LN STE 301302",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302545",
            "telephone_number": "571-223-7588"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 W. Perimeter Road Suite B5-19",
            "address_2": "779 Medical Group",
            "address_purpose": "LOCATION",
            "city": "Andrews AFB",
            "state": "MD",
            "postal_code": "20762",
            "country_code": "US",
            "telephone_number": "240-857-7186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COOLEY",
        "first_name": "NICOLE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "LCSW, BCD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-20",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904016120",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "35461",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Cook, OTR/L
• Sara A Cook, OTR/L, CHT
• Jennifer Cooke, ATC
• Sheila Kathleen Cooke, CRNA
• Emily Cookson, VATL, ATC, NREMT
• Angela Elaine Cooper
• Jennifer Cooper
• Mary H Cooper, LCSW
• Kaitlyn Coots, LPC
• Margaret Coots

• Clinical Social Worker in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.