Provider Demographics
NPI:1871023309
Name:COOKE, CONSILENA (LMT; NMT,)
Entity Type:Individual
Prefix:MS
First Name:CONSILENA
Middle Name:
Last Name:COOKE
Suffix:
Gender:F
Credentials:LMT; NMT,
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT; NMT,
Mailing Address - Street 1:1350 SCENIC HWY N STE 266
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7923
Mailing Address - Country:US
Mailing Address - Phone:678-948-8130
Mailing Address - Fax:
Practice Address - Street 1:1350 SCENIC HWY N STE 266
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7923
Practice Address - Country:US
Practice Address - Phone:678-948-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011258225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist