Provider Demographics
NPI:1164027330
Name:COOK, MARCY (LMBT)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMBT
Mailing Address - Street 1:1125 KILDAIRE FARM RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4566
Mailing Address - Country:US
Mailing Address - Phone:919-654-6919
Mailing Address - Fax:
Practice Address - Street 1:1125 KILDAIRE FARM RD STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4566
Practice Address - Country:US
Practice Address - Phone:919-654-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6580225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist