Provider Demographics
NPI:1891330387
Name:COOPER, JAMILA RASHIDA (LCMHCA)
Entity Type:Individual
Prefix:
First Name:JAMILA
Middle Name:RASHIDA
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 TANAWHA CT
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-6400
Mailing Address - Country:US
Mailing Address - Phone:408-204-0153
Mailing Address - Fax:
Practice Address - Street 1:241 GRANT ST
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-8377
Practice Address - Country:US
Practice Address - Phone:910-483-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NCA14281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health