Individual
VICKIE COOKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3806 RAVENWOOD AVE, BALTIMORE, MD 21213-2022
(443) 629-0646
Mailing address
PO BOX 3394, BALTIMORE, MD 21213-0394
(443) 629-0646
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCA3165
MD
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
SC1812
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SC1812
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
MD
Enumeration date
01/28/2016
Last updated
01/06/2023
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