Provider Demographics
NPI:1659965325
Name:COOLEY, JAWARA DIA (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JAWARA
Middle Name:DIA
Last Name:COOLEY
Suffix:
Gender:M
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14625 BALTIMORE AVE # 801
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4902
Mailing Address - Country:US
Mailing Address - Phone:202-734-6820
Mailing Address - Fax:
Practice Address - Street 1:14625 BALTIMORE AVE # 801
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4902
Practice Address - Country:US
Practice Address - Phone:202-734-6820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00826101YP2500X
DCPRC200001661101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional