Provider Demographics
NPI:1457836876
Name:COOPER, DARRECIA PRINCESS (MA)
Entity Type:Individual
Prefix:
First Name:DARRECIA
Middle Name:PRINCESS
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:DARRECIA
Other - Middle Name:PRINCESS
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:25835 MARY ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2824
Mailing Address - Country:US
Mailing Address - Phone:313-971-6693
Mailing Address - Fax:
Practice Address - Street 1:25835 MARY ST
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2824
Practice Address - Country:US
Practice Address - Phone:313-971-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018613101Y00000X, 101YP2500X
MI6401013594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor