Provider Demographics
NPI:1659528297
Name:COOK, NATASHA (PSYD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24947 VIRGINIA JUNIPER CT
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-6234
Mailing Address - Country:US
Mailing Address - Phone:703-439-8417
Mailing Address - Fax:
Practice Address - Street 1:24947 VIRGINIA JUNIPER CT
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-6234
Practice Address - Country:US
Practice Address - Phone:703-439-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000417103T00000X
MD04554103T00000X
VA0810005921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist