Provider Demographics
NPI:1912769852
Name:SHAKIB-COCKS, AVA BIBI (ASW)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:BIBI
Last Name:SHAKIB-COCKS
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22141 WREN WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1863
Mailing Address - Country:US
Mailing Address - Phone:949-632-7302
Mailing Address - Fax:
Practice Address - Street 1:426 4TH ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3401
Practice Address - Country:US
Practice Address - Phone:949-632-7302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115853104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker