Provider Demographics
NPI:1710768809
Name:COPELAND, WILLIAM BENJAMIN (LADAC II)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:COPELAND
Suffix:
Gender:M
Credentials:LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044-1620
Mailing Address - Country:US
Mailing Address - Phone:615-924-0274
Mailing Address - Fax:
Practice Address - Street 1:1169 NASHVILLE HWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2236
Practice Address - Country:US
Practice Address - Phone:865-378-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000001220101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)