Provider Demographics
NPI:1558488239
Name:COPELAND, SANDRA SUE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:SUE
Last Name:COPELAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED PROFESSIONA
Mailing Address - Street 1:345 GLEN COVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002
Mailing Address - Country:US
Mailing Address - Phone:404-292-5892
Mailing Address - Fax:
Practice Address - Street 1:21 EASTBROOK BEND
Practice Address - Street 2:SUITE 208
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269
Practice Address - Country:US
Practice Address - Phone:678-364-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002634101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor