Healthcare Provider Details

I. General information

NPI: 1235657701
Provider Name (Legal Business Name): BRITAINEY COOPER MA, ED.S, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 IRON GATE DR STE 101
WILMINGTON NC
28412-6624
US

IV. Provider business mailing address

440 MOTTS CREEK RD
WILMINGTON NC
28412-7854
US

V. Phone/Fax

Practice location:
  • Phone: 910-202-9113
  • Fax: 910-202-9289
Mailing address:
  • Phone: 304-377-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6627
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number46326
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: