Healthcare Provider Details

I. General information

NPI: 1225947815
Provider Name (Legal Business Name): GINA L COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 SUSAN WAY
SONORA CA
95370-9266
US

IV. Provider business mailing address

18443 HILLCREST RD
TWAIN HARTE CA
95383-9812
US

V. Phone/Fax

Practice location:
  • Phone: 209-517-2105
  • Fax:
Mailing address:
  • Phone: 209-517-2105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number32843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: