Provider Demographics
NPI:1609269000
Name:COPPES, OLIVIA SUSANNE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SUSANNE
Last Name:COPPES
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PARSONS DR APT 205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-3228
Mailing Address - Country:US
Mailing Address - Phone:814-251-3153
Mailing Address - Fax:
Practice Address - Street 1:1414 WESTWOOD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5149
Practice Address - Country:US
Practice Address - Phone:434-923-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000528103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst