Provider Demographics
NPI:1598207854
Name:COPELAND, YVONNEDA (LCSW)
Entity Type:Individual
Prefix:
First Name:YVONNEDA
Middle Name:
Last Name:COPELAND
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 1:14071 BIG CREST LN
Mailing Address - Street 2:208
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5573
Mailing Address - Country:US
Mailing Address - Phone:469-544-9932
Mailing Address - Fax:
Practice Address - Street 1:14071 BIG CREST LN
Practice Address - Street 2:208
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5573
Practice Address - Country:US
Practice Address - Phone:469-544-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9040072921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical