MEDICARE: RENEE COOPER MS, LCAS, CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1326699984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE COOPER MS, LCAS, CADC

Provider Business Mailing Address
First Line	:	4746 MAPLE HILL RD SW
Second Line	:
City	:	SHALLOTTE
State	:	NC
Zip	:	28470-5010
Country	:	US
Telephone Number	:	910-386-2044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 ASH LITTLE RIVER RD NW
Second Line	:
City	:	ASH
State	:	NC
Zip	:	28420-1700
Country	:	US
Telephone Number	:	910-386-2044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	11/09/2022

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