Healthcare Provider Details

I. General information

NPI: 1023708302
Provider Name (Legal Business Name): KEARA KATHERINE COOPER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 ORIANA RD STE 2
NEWPORT NEWS VA
23608-3742
US

IV. Provider business mailing address

445 ORIANA RD STE 2
NEWPORT NEWS VA
23608-3742
US

V. Phone/Fax

Practice location:
  • Phone: 646-604-1153
  • Fax: 276-300-1350
Mailing address:
  • Phone: 757-603-1153
  • Fax: 276-300-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904015254
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: