Provider Demographics
NPI:1396819702
Name:COOKE, MARCIA ANTOINETTE (IMF)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANTOINETTE
Last Name:COOKE
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10717 CAMINO RUIZ
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2360
Mailing Address - Country:US
Mailing Address - Phone:858-695-2211
Mailing Address - Fax:858-695-3521
Practice Address - Street 1:10717 CAMINO RUIZ
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2360
Practice Address - Country:US
Practice Address - Phone:858-695-2211
Practice Address - Fax:858-695-3521
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health