Provider Demographics
NPI:1033475488
Name:COOPER, ANDREA (LPC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 SAMANTHA LN APT 404
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3932
Mailing Address - Country:US
Mailing Address - Phone:703-609-5668
Mailing Address - Fax:
Practice Address - Street 1:2029 P ST NW
Practice Address - Street 2:SUITE 202
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5948
Practice Address - Country:US
Practice Address - Phone:703-709-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004039101YP2500X
DCPRC14178101YP2500X
MDLC4861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional