Provider Demographics
NPI:1548455082
Name:COOKE, PHILLIS KAY (LCSWC BCD)
Entity type:Individual
Prefix:MS
First Name:PHILLIS
Middle Name:KAY
Last Name:COOKE
Suffix:
Gender:F
Credentials:LCSWC BCD
Other - Prefix:MS
Other - First Name:PHILLIS
Other - Middle Name:WALLS
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSWC BCD
Mailing Address - Street 1:913 S BELGRADE ROAD
Mailing Address - Street 2:PHILLIS COOKE
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3252
Mailing Address - Country:US
Mailing Address - Phone:301-649-1415
Mailing Address - Fax:301-649-2127
Practice Address - Street 1:913 S BELGRADE ROAD
Practice Address - Street 2:PHILLIS COOKE
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3252
Practice Address - Country:US
Practice Address - Phone:301-649-1415
Practice Address - Fax:301-649-2127
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01017104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker