Provider Demographics
NPI:1083878474
Name:COOPER, NATASHA MARIE
Entity Type:Individual
Prefix:MISS
First Name:NATASHA
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 SLOPING OAKS RD APT 306
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-7327
Mailing Address - Country:US
Mailing Address - Phone:704-953-3562
Mailing Address - Fax:
Practice Address - Street 1:5800 SLOPING OAKS RD APT 306
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-7327
Practice Address - Country:US
Practice Address - Phone:704-953-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health