Healthcare Provider Details

I. General information

NPI: 1376587931
Provider Name (Legal Business Name): BARBARA L COOPER MSW, LCSW, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1977 J N PEASE PL
CHARLOTTE NC
28262-4528
US

IV. Provider business mailing address

1412 S YORK RD
GASTONIA NC
28052-6158
US

V. Phone/Fax

Practice location:
  • Phone: 704-503-3535
  • Fax: 704-593-5555
Mailing address:
  • Phone: 704-867-0448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004975
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: