Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 10590 | MA |
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1470 | SC |
NPI | 1497188999 |
---|---|
Provider Name | Dr. Michelle P Cooke |
First Address | Mount Pleasant, SC 29466-9386 |
Second Address | North Charleston, SC 29405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2013 |
Last Update Date | 06/12/2019 |