Provider Demographics
NPI:1154641918
Name:COOPER, DARLENE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PROMINENCE CT
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-8953
Mailing Address - Country:US
Mailing Address - Phone:888-850-4891
Mailing Address - Fax:888-447-9197
Practice Address - Street 1:137 PROMINENCE CT
Practice Address - Street 2:SUITE 120
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-8953
Practice Address - Country:US
Practice Address - Phone:888-850-4891
Practice Address - Fax:888-447-9197
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional