Provider Demographics
NPI:1326177635
Name:COOKSON, TERRY LEE (ND, MSOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:COOKSON
Suffix:
Gender:F
Credentials:ND, MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7106
Mailing Address - Country:US
Mailing Address - Phone:207-557-2557
Mailing Address - Fax:207-623-4233
Practice Address - Street 1:12 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7106
Practice Address - Country:US
Practice Address - Phone:207-557-2557
Practice Address - Fax:207-623-4233
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC 267171100000X
MENP 266175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath