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General NPI Number Information
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NPI Number | 1487712907
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Entity Type | Individual
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Provider Name | PHYLLIS T. COOK CAC-AD, CCDC, ICADC
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2823 OCEAN GTWY
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City | CAMBRIDGE
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State | MD
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Zip | 21613-3403
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Country | US
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Telephone | 410-221-6343
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Fax | 410-221-6342
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Provider Business Mailing Address
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Address Line | 8715 SHADOW LN
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City | DELMAR
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State | MD
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Zip | 21875-2551
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Country | US
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Telephone | 410-221-6343
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Fax | 410-221-6342
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AC0191
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License Number State | MD
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