Provider Demographics
NPI:1679526750
Name:COOPER, CHARLES L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:COOPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EUROPA DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2357
Mailing Address - Country:US
Mailing Address - Phone:919-929-1227
Mailing Address - Fax:919-968-2575
Practice Address - Street 1:100 EUROPA DR
Practice Address - Street 2:SUITE 260
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2357
Practice Address - Country:US
Practice Address - Phone:919-929-1227
Practice Address - Fax:919-968-2575
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC404103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC404OtherPRACTICINGPSYCHOL LICENSE
NC2810913Medicare ID - Type UnspecifiedMEDICAREPROV#