Provider Demographics
NPI:1346373776
Name:COOPER, SEQUIDA D (LPC)
Entity Type:Individual
Prefix:MS
First Name:SEQUIDA
Middle Name:D
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:SEQUIDA
Other - Middle Name:D
Other - Last Name:WYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2008 STONEY BROOK CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2273
Mailing Address - Country:US
Mailing Address - Phone:989-475-1232
Mailing Address - Fax:
Practice Address - Street 1:2425 S LINDEN RD STE D
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5474
Practice Address - Country:US
Practice Address - Phone:810-339-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI6401018019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)