Provider Demographics
NPI:1407030711
Name:COOPER, SARAH MOORE (MSW, LCAS, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MOORE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MSW, LCAS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 CHEVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4931
Mailing Address - Country:US
Mailing Address - Phone:704-617-0756
Mailing Address - Fax:
Practice Address - Street 1:120 GREENWICH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2314
Practice Address - Country:US
Practice Address - Phone:704-617-0756
Practice Address - Fax:704-870-3875
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1564101YA0400X
NCC0067471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112130Medicaid