Healthcare Provider Details

I. General information

NPI: 1013508993
Provider Name (Legal Business Name): MARY AMY LYNN COOPER LCAS, LCMHCA, CSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 E MAIN ST
SPINDALE NC
28160-1938
US

IV. Provider business mailing address

6172 LITTLE MOUNTAIN RD
SHERRILLS FORD NC
28673-7833
US

V. Phone/Fax

Practice location:
  • Phone: 980-389-4291
  • Fax:
Mailing address:
  • Phone: 980-389-4291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17134
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-26622
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: