Healthcare Provider Details

I. General information

NPI: 1164993143
Provider Name (Legal Business Name): SANDRA COOPER, RN, LPCMH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 KIRKWOOD HWY., SUITE 320
NEWARK DE
19711
US

IV. Provider business mailing address

8 ALDRIDGE CT
NEWARK DE
19702-2154
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-4539
  • Fax: 302-266-0881
Mailing address:
  • Phone: 302-738-4539
  • Fax: 302-266-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRA COOPER
Title or Position: OWNER/
Credential: LPCMH
Phone: 302-738-4539