Provider Demographics
NPI:1104364603
Name:COOPER, JUDIET (MASTER, MENTAL HEALT)
Entity Type:Individual
Prefix:
First Name:JUDIET
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MASTER, MENTAL HEALT
Other - Prefix:
Other - First Name:JUDIET
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASTER, MENTAL HEALT
Mailing Address - Street 1:709 MILL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4738
Mailing Address - Country:US
Mailing Address - Phone:803-432-6902
Mailing Address - Fax:803-432-6860
Practice Address - Street 1:709 MILL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4738
Practice Address - Country:US
Practice Address - Phone:803-432-6902
Practice Address - Fax:803-432-6890
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health