Provider Demographics
NPI:1699191098
Name:COOPER, MARIA (EDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 COLLETON LOOP
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-3069
Mailing Address - Country:US
Mailing Address - Phone:843-782-0031
Mailing Address - Fax:
Practice Address - Street 1:611 COLLETON LOOP
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-3069
Practice Address - Country:US
Practice Address - Phone:843-782-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC258454103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool