Provider Demographics
NPI:1346805884
Name:COOPER, SUSANNA (LCPC)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 KINGS COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1824
Mailing Address - Country:US
Mailing Address - Phone:443-995-2203
Mailing Address - Fax:
Practice Address - Street 1:170 JENNIFER RD STE 202
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3064
Practice Address - Country:US
Practice Address - Phone:443-995-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health