Provider Demographics
NPI:1982058285
Name:COOLEY, WILLINTON (MA)
Entity type:Individual
Prefix:
First Name:WILLINTON
Middle Name:
Last Name:COOLEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 LINCOLN PKWY E STE 120
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2227
Mailing Address - Country:US
Mailing Address - Phone:678-824-6590
Mailing Address - Fax:678-824-6597
Practice Address - Street 1:1455 LINCOLN PKWY E STE 120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-2227
Practice Address - Country:US
Practice Address - Phone:678-824-6590
Practice Address - Fax:678-824-6597
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health