Provider Demographics
NPI:1609383504
Name:COOK, FAITH (MA)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 QUEEN ANN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-7464
Mailing Address - Country:US
Mailing Address - Phone:804-356-4744
Mailing Address - Fax:866-355-8910
Practice Address - Street 1:1411 QUEEN ANN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-7464
Practice Address - Country:US
Practice Address - Phone:804-356-4744
Practice Address - Fax:866-355-8910
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor