Provider Demographics
NPI:1245118819
Name:COOPER, DECORA (LCAS-A)
Entity type:Individual
Prefix:
First Name:DECORA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:MS
Other - First Name:DECORA
Other - Middle Name:
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DECORA DEAN
Mailing Address - Street 1:2336 FARMER ST APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5695
Mailing Address - Country:US
Mailing Address - Phone:704-449-8735
Mailing Address - Fax:
Practice Address - Street 1:59 WINECOFF AVE NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4431
Practice Address - Country:US
Practice Address - Phone:980-243-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30609101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)