Provider Demographics
NPI:1467110965
Name:COOKS, MARJORIE AKINS (CBHCM)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:AKINS
Last Name:COOKS
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-6132
Mailing Address - Country:US
Mailing Address - Phone:386-855-3108
Mailing Address - Fax:
Practice Address - Street 1:7150 NW 22ND DR
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:FL
Practice Address - Zip Code:32053-2367
Practice Address - Country:US
Practice Address - Phone:386-938-2097
Practice Address - Fax:386-487-0366
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM103073171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator