Provider Demographics
NPI:1568751139
Name:COOPER, VICKI LANE
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LANE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:VICKI
Other - Middle Name:LANE
Other - Last Name:TRAMMELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1167 SPRATLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6205
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:498 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-5400
Practice Address - Country:US
Practice Address - Phone:423-878-1600
Practice Address - Fax:423-467-3644
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor