Provider Demographics
NPI:1255075743
Name:COOK, DEMONE LEE SR (CADC II-CS)
Entity type:Individual
Prefix:MR
First Name:DEMONE
Middle Name:LEE
Last Name:COOK
Suffix:SR
Gender:M
Credentials:CADC II-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1226
Mailing Address - Country:US
Mailing Address - Phone:661-388-9846
Mailing Address - Fax:
Practice Address - Street 1:2120 3RD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1226
Practice Address - Country:US
Practice Address - Phone:661-388-9846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052731221101YA0400X
CACS0961221101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)