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General NPI Number Information
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NPI Number | 1750756524
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Entity Type | Individual
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Provider Name | KATRINA COOPER
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Gender | Female
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Dates
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Enumeration Date | 12/04/2015
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 2830 BURTONS FERRY HWY
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City | SYLVANIA
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State | GA
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Zip | 30467-4513
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Country | US
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Telephone | 800-317-0364
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 N COLUMBIA AVE UNIT 4
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City | RINCON
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State | GA
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Zip | 31326-6825
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Country | US
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Telephone | 800-317-0364
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC006513
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License Number State | GA
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