Healthcare Provider Details

I. General information

NPI: 1619218583
Provider Name (Legal Business Name): SANDRA COOPER LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2013
Last Update Date: 03/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 MILLTOWN RD
WILMINGTON DE
19808-3909
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: 302-379-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0000629
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: