Healthcare Provider Details

I. General information

NPI: 1679703391
Provider Name (Legal Business Name): RHEA JANELLE COOPER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20100 GREENFIELD
DETROIT MI
48235
US

IV. Provider business mailing address

129 E. THIRD ST.
FLINT MI
48502
US

V. Phone/Fax

Practice location:
  • Phone: 313-342-2699
  • Fax: 313-342-2180
Mailing address:
  • Phone: 313-342-2699
  • Fax: 313-831-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089993
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: