Provider Demographics
NPI:1043908692
Name:COOPER, FELICIA CECILE (LPC)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:CECILE
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:PO BOX 80397
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-8397
Mailing Address - Country:US
Mailing Address - Phone:404-987-0785
Mailing Address - Fax:770-760-8035
Practice Address - Street 1:3675 DANIEL BRIDGE RD SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6044
Practice Address - Country:US
Practice Address - Phone:404-987-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008051101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional