=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558232736
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REESE COOPER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2025
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 890 S KERR AVE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28403-4245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-714-4283
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2406 FLOWERY BRANCH DR
-----------------------------------------------------
City | CASTLE HAYNE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28429-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | P022991
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------