Shawandalyn Latrelle Cooley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904009596 Issued in VA

Practice address

825 Gum Branch Rd
Suite 133
Jacksonville, NC 28540-6298

Phone

(910) 346-6726

Fax

(910) 346-8285

NPI assigned

Dec 27, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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.

• Axis Healthcare Group

  • Psychiatry Physician
  • Silver Spring, MD
  • NPI 1326295098
  NPD
• Elbert C Owens LPC PC

  • Professional Counselor
  • Jacksonville, NC
  • NPI 1881724763
  NPD (past)
• MCS, PC

  • Community/Behavioral Health Agency
  • Silver Spring, MD
  • NPI 1538717723

  Clinical

  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1376608653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8040 GEORGIA AVE STE 170",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209104959",
            "telephone_number": "202-360-4787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 GUM BRANCH RD",
            "address_2": "SUITE 133",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285406298",
            "telephone_number": "910-346-6726",
            "fax_number": "910-346-8285"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4250 Fairfax Dr Ste 600",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "VA",
            "postal_code": "222031665",
            "country_code": "US",
            "telephone_number": "202-360-4787",
            "fax_number": "202-360-4787",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8040 Georgia Ave Ste 170",
            "address_purpose": "LOCATION",
            "city": "Silver Spring",
            "state": "MD",
            "postal_code": "209104959",
            "country_code": "US",
            "telephone_number": "202-360-4787",
            "fax_number": "202-360-4787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COOLEY",
        "first_name": "SHAWANDALYN",
        "middle_name": "LATRELLE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "24269",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904009596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300057B",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Continuum II Home Care and Hospice, Inc.
• Alina Smith Cook
• Candace Faith Cook
• Jacqueline Gale Cook
• Stephanie Cooke, BCBA, LBA NC
• Andrea Cooper, MS, LCMHC
• Paul Cooper
• Coordinated Health Services, Inc.
• Rachel Copelan
• Olivia Marie Corallo, MS, LCAS-A, LCMHC-A

• All providers in Jacksonville, NC
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.