Provider Demographics
NPI:1134933112
Name:COOK, CAMIYA ELICIA-REI I
Entity type:Individual
Prefix:
First Name:CAMIYA
Middle Name:ELICIA-REI
Last Name:COOK
Suffix:I
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAMIYA
Other - Middle Name:ELICIA-REI
Other - Last Name:COOK
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:CAMIYA COOK
Mailing Address - Street 1:716 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2212
Mailing Address - Country:US
Mailing Address - Phone:916-912-7075
Mailing Address - Fax:916-912-7075
Practice Address - Street 1:716 ARTHUR DR
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-2212
Practice Address - Country:US
Practice Address - Phone:916-912-7075
Practice Address - Fax:916-912-7075
Is Sole Proprietor?:No
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician