Provider Demographics
NPI:1962661710
Name:COOK, COLLEEN MARIE
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARIE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:COOK-CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4600 EMPEROR BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8577
Mailing Address - Country:US
Mailing Address - Phone:919-651-8489
Mailing Address - Fax:
Practice Address - Street 1:4600 EMPEROR BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8577
Practice Address - Country:US
Practice Address - Phone:919-651-8489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6456101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health