Provider Demographics
NPI:1295579449
Name:COOKE, DAMON LAVAUGHN (LCD SUD COUNSELOR)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:LAVAUGHN
Last Name:COOKE
Suffix:
Gender:M
Credentials:LCD SUD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 GORDON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-8614
Mailing Address - Country:US
Mailing Address - Phone:707-319-7145
Mailing Address - Fax:707-703-5794
Practice Address - Street 1:6355 GORDON VALLEY RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-8614
Practice Address - Country:US
Practice Address - Phone:707-319-7145
Practice Address - Fax:707-703-5794
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty