Margaret Cook, NP
Inclusive psychiatric care for children, adolescents, and adults in Richmond and greater Virginia.
Welcome!
Thank you for visiting! My name is Margaret (she/her), and I’m a Psychiatric-Mental Health Nurse Practitioner (PMHNP). I provide psychiatric care in Richmond, VA to children through young adults, with a focus the mental health needs of the neurodivergent and queer community.
About:
I am a solo-practitioner, one-person operation. I began this practice in 2024 to offer an alternative to corporate, generic, assembly-line mental health care. I wanted to create a space where individuals feel heard, valued, and understood, and where your lived experience is at the center of your care. Psychiatry has long been an unsafe space for individuals from many groups - people of color, queer and gender non-conforming people, women, disabled people - as there is an extensive history of psychiatry being used a tool of oppression towards these groups. My goal is to provide mental health care that actually feels safe, accessible, nonjudgmental, and nonviolent. I believe the first step of this is to acknowledge the harm psychiatry has caused in the past, to acknowledge the harm it still inflicts to this day, and to acknowledge the systemic biases that infiltrate every aspect of the medical system. My practice is explicitly social justice oriented with a focus on not just acceptance, but rather affirmation of neurodivergence, gender-nonconformity/transgender rights, bodily autonomy and reproductive rights, and anti-racism. I do not believe that issues of oppression and identity are "political" - I believe they are at the very core of mental healthcare, since mental health does not exist in a vacuum - I do not feel you can claim to care about mental health if you remain silent as the rights and humanity of entire groups of people are belittled and taken away. Seeing someone as a full human being means looking at their entire experience - the impact of their race, ethnicity/culture, their physical abilities or disabilities, their gender expression and identity, their sexual orientation, their economic and class background - you cannot fully see or know a person without appreciating how each of these has shaped their identity formation. You cannot disentangle mental health advocacy from anti-oppression, social justice work; to pretend otherwise is disingenuous at best. This is why I consider social justice advocacy the core of my practice philosophy. Individuals who do not affirm these values are not a good fit for my practice.
Practice overview:
My initial evaluations are 90 minutes long. My goal is to be as thorough as possible so I can fully understand your history, experience, and goals. Subsequently, we'll make a plan about medication changes and adjustments. I practice with a focus on de-prescribing, meaning cleaning up unnecessary and excessive medication regimens and working with individuals to achieve their goals on as few medications as possible. I am conservative with controlled substances and place a heavy emphasis on safety. Follow up appointments are typically 30 minutes. The frequency of appointments varies based on individual needs - we may meet every 2 weeks if we're making significant changes, and we can push out sessions farther apart once we feel like you're closer to your goals and no longer require such close monitoring. The maximum time that can go between appointments is 3 months. There is no requirement to take medications to work with me; however, it is important to make the distinction that as psychiatric NP, my role is different than that of a psychotherapist; therapy is certainly a component of our work, as I reject the reductionist concept of "medication management" and value our relationship beyond the prescription of medications. However, most patients also work with a psychotherapist in addition to myself for a more comprehensive, collaborative team approach. There is much overlap in the roles, but it is an important distinction to clarify the different scopes of practice, education, and services provided.
About me:
I have been a PMHNP since 2017, and before that a psychiatric nurse since 2013. I received both my BSN and MSN at Virginia Commonwealth University, where I have also served as adjunct faculty. I've worked in many different settings, including acute inpatient, eating disorders, child and adolescent, PHP and IOP, consult liaison, and corrections. I was born and raised in Cambridge, MA. After graduating high school, I spent two years living and working in an egalitarian community of about 100 here in Virginia, where income and resources are shared equally among all members. After two years there, I moved to Oakland, CA to earn my BA at Mills College with a major in French and Francophone Studies and a minor in psychology. At Mills, I was inducted into the Phi Beta Kappa honor society and won the French Prize. It was there that. I learned what a nurse practitioner was and immediately felt called to the role, and made plans to return to Virginia to begin the NP journey. I have three daughters, each born at home with under the care of an incredible nurse midwife. I'm married to a Richmond City firefighter. I am a musical theater fanatic with a particular passion for Les Mis, which I have seen upwards of 25 times. My other favorites are Rent, The Outsiders, Ragtime, Hamilton, Miss Saigon, and too many others to count. I am an avowed cat person but at the time being am the human companion of a Quaker parrot named Buddy.
Please note:
As a solo practitioner without support staff, I have limitations on what I can provide. Please carefully review the following when determining if I'll be a good fit for you: I cannot provide crisis management, and do not provide any type of after hours call. I am not able to support individuals who need significant care outside of scheduled sessions. A larger practice with 24/7 call would be a more appropriate fit. My schedule is limited, and I can only rarely accommodate late afternoon appointments. If you are not able to meet before 3pm, I will not be a good fit for you. If you have medical conditions that impact your psychiatric care and require extensive monitoring and medical oversight, you would be better served by an integrated medical/psychiatric practice where collaboration is much more easy when medical and psychiatric providers are all under one roof and can easily view one another's notes, communicate, order/review tests, etc. I do not provide detox or MAT therapy. I am conservative with controlled substances (stimulants, benzodiazepines) and have a strict controlled substance policy that must be signed. If you are currently on a controlled substance, I cannot guarantee I will continue that medication depending on clinical evaluation and judgment. I am not able to take individuals on high daily doses of benzodiazepines (Xanax, Ativan, Klonopin, etc) as such regimens are often dangerous and can present a medical risk and may require detox.
Insurance Accepted:
Cigna Anthem BCBS Aetna United Optum Oscar Oxford Sentara I utilize Headway for insurance verification and billing; before starting services together, you will need to make a Headway account so we can make sure I'm in your network. Please click below to verify insurance coverage before we start together. Any questions about insurance coverage, benefits, or billing should be directed to Headway, as I outsource the financial management of my practice to them.