Provider Demographics
NPI:1831854330
Name:COOK, JODI (NCC, LCPC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 DUNMANWAY
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-5352
Mailing Address - Country:US
Mailing Address - Phone:443-809-7187
Mailing Address - Fax:
Practice Address - Street 1:7400 DUNMANWAY
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-5352
Practice Address - Country:US
Practice Address - Phone:443-809-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12111101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor