Healthcare Provider Details

I. General information

NPI: 1588406540
Provider Name (Legal Business Name): MARKITA RENEE COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 EASTERN AVE
BALTIMORE MD
21224-4108
US

IV. Provider business mailing address

928 N STRICKER ST APT 2
BALTIMORE MD
21217-2160
US

V. Phone/Fax

Practice location:
  • Phone: 443-708-5056
  • Fax: 443-449-7897
Mailing address:
  • Phone: 667-434-7603
  • Fax: 443-449-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: