Provider Demographics
NPI:1518044015
Name:COOPER, LINDA JOYCE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JOYCE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 LITTLE EGRET RUN
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4108
Mailing Address - Country:US
Mailing Address - Phone:910-409-3080
Mailing Address - Fax:910-383-2113
Practice Address - Street 1:1008 LITTLE EGRET RUN
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4108
Practice Address - Country:US
Practice Address - Phone:910-409-3080
Practice Address - Fax:910-383-2113
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health