Provider Demographics
NPI:1003476466
Name:COOPER, SHAQUILLA N (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAQUILLA
Middle Name:N
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 BOLLING AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40210-1908
Mailing Address - Country:US
Mailing Address - Phone:502-618-9205
Mailing Address - Fax:502-963-5135
Practice Address - Street 1:1828 BOLLING AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40210-1908
Practice Address - Country:US
Practice Address - Phone:502-536-7245
Practice Address - Fax:502-963-5135
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2542141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical