Provider Demographics
NPI:1326699984
Name:COOPER, RENEE (MS, LCAS, CADC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MS, LCAS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4746 MAPLE HILL RD SW
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-5010
Mailing Address - Country:US
Mailing Address - Phone:910-386-2044
Mailing Address - Fax:
Practice Address - Street 1:1636 ASH LITTLE RIVER RD NW
Practice Address - Street 2:
Practice Address - City:ASH
Practice Address - State:NC
Practice Address - Zip Code:28420-1700
Practice Address - Country:US
Practice Address - Phone:910-386-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)