Provider Demographics
NPI:1497132450
Name:COPELAND, DAVID I (MA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:I
Last Name:COPELAND
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 WILDFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3273
Mailing Address - Country:US
Mailing Address - Phone:850-217-7950
Mailing Address - Fax:
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW STE 3
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5253
Practice Address - Country:US
Practice Address - Phone:850-862-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17022101YP1600X
FLMH13748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral