Provider Demographics
NPI:1629962477
Name:COOK, ASHLEY DOMINIQUE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DOMINIQUE
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 CENTRAL AVE
Mailing Address - Street 2:SUITE D BOX 4
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519
Mailing Address - Country:US
Mailing Address - Phone:707-630-4000
Mailing Address - Fax:
Practice Address - Street 1:2355 CENTRAL AVE STE D
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3684
Practice Address - Country:US
Practice Address - Phone:707-630-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician