Provider Demographics
NPI:1790963023
Name:COOKS, JANICE MARIE (CAC)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARIE
Last Name:COOKS
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5987 PATTILLO LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6295
Mailing Address - Country:US
Mailing Address - Phone:678-778-0637
Mailing Address - Fax:678-691-0763
Practice Address - Street 1:5987 PATTILLO LN
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6295
Practice Address - Country:US
Practice Address - Phone:678-778-0637
Practice Address - Fax:678-691-0763
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)