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General NPI Number Information
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NPI Number | 1952410607
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Entity Type | Individual
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Provider Name | VICTORIA R COPELTON LCSW, LCAS
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 160 CHURCHILL DOWNS DR JOHNSTON COUNSELING SERVICES INC.
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City | CLAYTON
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State | NC
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Zip | 27520-5536
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Country | US
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Telephone | 919-550-6646
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Fax |
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Provider Business Mailing Address
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Address Line | 160 CHURCHILL DOWNS DR EASTMAINSTREETCOUNSELING
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City | CLAYTON
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State | NC
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Zip | 27520-5536
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Country | US
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Telephone | 919-333-1397
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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 | 922
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C004467
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License Number State | NC
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