Provider Demographics
NPI:1851004410
Name:COOK, JOCELYN MARIE
Entity Type:Individual
Prefix:MISS
First Name:JOCELYN
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7375 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3158
Mailing Address - Country:US
Mailing Address - Phone:313-710-8744
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:7375 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3158
Practice Address - Country:US
Practice Address - Phone:313-710-8744
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician