Provider Demographics
NPI:1881220465
Name:COOK, VICTORIA ANN
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
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 1:107 PARK VIEW CT
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-3652
Mailing Address - Country:US
Mailing Address - Phone:985-662-2850
Mailing Address - Fax:
Practice Address - Street 1:107 PARK VIEW CT
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-3652
Practice Address - Country:US
Practice Address - Phone:985-662-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst