Provider Demographics
NPI:1780215442
Name:COOPER, VICTORIA (CIT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:BUTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CIT
Mailing Address - Street 1:112 E CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 W BAYOU ST
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-2707
Practice Address - Country:US
Practice Address - Phone:318-368-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)