MEDICARE: CLERISSA COOPER LAPC

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	APC0003587	GA

General Provider Information

NPI Number	:	1558741942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLERISSA COOPER LAPC

Provider Business Mailing Address
First Line	:	6 CONCOURSE PKWY
Second Line	:	SUITE 1650
City	:	ATLANTA
State	:	GA
Zip	:	30328-6117
Country	:	US
Telephone Number	:	404-408-2950
Fax Number	:	770-804-0018

Provider Business Practice Location Address
First Line	:	6 CONCOURSE PKWY
Second Line	:	SUITE 1650
City	:	ATLANTA
State	:	GA
Zip	:	30328-6117
Country	:	US
Telephone Number	:	404-408-2950
Fax Number	:	770-804-0018

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

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	06/01/2015

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Directions to “ CLERISSA COOPER LAPC” Practice Location

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