Doctor Name: | MRS. KATHERINE M MARKS COOK |
NPI Number: | 1174603476 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW LADC |
License Number: | LC2728 |
Business Practice Address: | 30 Boynton St Box H Eastport Health Care Inc Eastport, ME - 04631 |
Business Phone Number: | 2078536001 |
Business Fax Number: | 2078534028 |
Mailing Address: | 30 Boynton St, Box H Eastport Health Care Inc EASTPORT |
State: | ME |
Postal Code: | 04631 |
Phone Number: | 2078536001 |
Fax Number: | 2078534028 |
NPI Enumeration Date: | 10/17/2006 |
NPI Last Update Date: | 06/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | LC2728 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |