Provider Demographics
NPI:1457484909
Name:COOPER, SHARON M (MA IN COUNSELING)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:M
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA IN COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-3143
Mailing Address - Country:US
Mailing Address - Phone:843-661-4870
Mailing Address - Fax:843-661-4873
Practice Address - Street 1:608 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3410
Practice Address - Country:US
Practice Address - Phone:843-661-4870
Practice Address - Fax:843-661-4873
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC376241Medicaid
SC376241Medicaid