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General NPI Number Information
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NPI Number | 1205063310
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Entity Type | Individual
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Provider Name | MADONNA COOPER POOL MS., LCADC, LCPC
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Gender | Female
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 3783 PLEASANT VALLEY RD
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City | OAKLAND
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State | MD
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Zip | 21550-5609
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Country | US
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Telephone | 301-616-7469
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Fax |
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Provider Business Mailing Address
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Address Line | 331 EARL HAUSER RD
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City | OAKLAND
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State | MD
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Zip | 21550-2418
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Country | US
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Telephone | 301-334-0565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCA201
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC1504
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 60402
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License Number State | NC
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