Provider Demographics
NPI:1669661187
Name:COOK, DAVID (MS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1046
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-1046
Mailing Address - Country:US
Mailing Address - Phone:662-627-7267
Mailing Address - Fax:662-627-5240
Practice Address - Street 1:300 FAIRLAND HWY 49 SOUTH
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:MS
Practice Address - Zip Code:38739
Practice Address - Country:US
Practice Address - Phone:662-624-5332
Practice Address - Fax:662-627-5240
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)