Healthcare Provider Details

I. General information

NPI: 1457836876
Provider Name (Legal Business Name): DARRECIA PRINCESS COOPER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DARRECIA PRINCESS COOPER LPC

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25835 MARY ST
CHESTERFIELD MI
48051-2824
US

IV. Provider business mailing address

25835 MARY ST
CHESTERFIELD MI
48051-2824
US

V. Phone/Fax

Practice location:
  • Phone: 248-500-6411
  • Fax: 586-684-4291
Mailing address:
  • Phone: 313-971-6693
  • Fax: 586-684-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013594
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018613
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401018613
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: