Provider Demographics
NPI:1255547865
Name:COOKE, DELAINE CHRISTINE (CO508241617)
Entity type:Individual
Prefix:MS
First Name:DELAINE
Middle Name:CHRISTINE
Last Name:COOKE
Suffix:
Gender:F
Credentials:CO508241617
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221B S LENORE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3632
Mailing Address - Country:US
Mailing Address - Phone:707-456-3853
Mailing Address - Fax:707-456-3808
Practice Address - Street 1:1120 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6340
Practice Address - Country:US
Practice Address - Phone:707-463-6314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABRA-S7-0175101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)