Healthcare Provider Details

I. General information

NPI: 1588587786
Provider Name (Legal Business Name): JANISA COOKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 HOLLAND RD
SUFFOLK VA
23434-6313
US

IV. Provider business mailing address

2016 BROOKLAND DR APT D
CHESAPEAKE VA
23324-4600
US

V. Phone/Fax

Practice location:
  • Phone: 804-223-3410
  • Fax:
Mailing address:
  • Phone:
  • Fax: 757-292-7638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5826
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: