Provider Demographics
NPI:1619743689
Name:COPISAROW, EMMA ELIZABETH (LPA)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:ELIZABETH
Last Name:COPISAROW
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 CARMEL EXECUTIVE PARK DR STE 302
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4204
Mailing Address - Country:US
Mailing Address - Phone:704-251-9084
Mailing Address - Fax:877-513-7720
Practice Address - Street 1:7301 CARMEL EXECUTIVE PARK DR STE 302
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4204
Practice Address - Country:US
Practice Address - Phone:704-251-9084
Practice Address - Fax:877-513-7720
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6479103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical