Provider Demographics
NPI:1003150632
Name:COOPER, ALLEGRA SHONTA (LCMHC)
Entity Type:Individual
Prefix:
First Name:ALLEGRA
Middle Name:SHONTA
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:ALLEGRA
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCA
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6324 FAIRVIEW RD STE 460
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3374
Practice Address - Country:US
Practice Address - Phone:980-302-8611
Practice Address - Fax:980-302-8624
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9259101Y00000X
NC9259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor