Provider Demographics
NPI:1164993143
Name:SANDRA COOPER, RN, LPCMH, LLC
Entity Type:Organization
Organization Name:SANDRA COOPER, RN, LPCMH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMH
Authorized Official - Phone:302-738-4539
Mailing Address - Street 1:8 ALDRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2154
Mailing Address - Country:US
Mailing Address - Phone:302-738-4539
Mailing Address - Fax:302-266-0881
Practice Address - Street 1:2644 KIRKWOOD HWY., SUITE 320
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-738-4539
Practice Address - Fax:302-266-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty