MEDICARE: FELICIA CECILE COOPER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC008051	GA

General Provider Information

NPI Number	:	1043908692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA CECILE COOPER LPC

Provider Business Mailing Address
First Line	:	PO BOX 80397
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-8397
Country	:	US
Telephone Number	:	404-987-0785
Fax Number	:	770-760-8035

Provider Business Practice Location Address
First Line	:	3675 DANIEL BRIDGE RD SW
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-6044
Country	:	US
Telephone Number	:	404-987-0785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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