Provider Demographics
NPI:1376282962
Name:COOKS, SELENA LAKISHA
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:LAKISHA
Last Name:COOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-0344
Mailing Address - Country:US
Mailing Address - Phone:443-317-3392
Mailing Address - Fax:
Practice Address - Street 1:6410 DOBBIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4774
Practice Address - Country:US
Practice Address - Phone:443-317-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101Y00000XBehavioral Health & Social Service ProvidersCounselor