Provider Demographics
NPI:1619754173
Name:COOMER, EMILY JOY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JOY
Last Name:COOMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:COOMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCA
Mailing Address - Street 1:2040 ASHLEY RIVER RD APT 107
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-8000
Mailing Address - Country:US
Mailing Address - Phone:763-350-1308
Mailing Address - Fax:
Practice Address - Street 1:29 LEINBACH DR STE B4
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7088
Practice Address - Country:US
Practice Address - Phone:843-501-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health