Provider Demographics
NPI:1922595446
Name:COOPER, KALE (LMSW)
Entity Type:Individual
Prefix:
First Name:KALE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KALE
Other - Middle Name:
Other - Last Name:HERNDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:700 COMMERCIAL CT STE 102
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3675
Mailing Address - Country:US
Mailing Address - Phone:912-503-5744
Mailing Address - Fax:912-335-6559
Practice Address - Street 1:700 COMMERCIAL CT STE 102
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3675
Practice Address - Country:US
Practice Address - Phone:912-503-5744
Practice Address - Fax:912-335-6559
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007300104100000X
NY1064141041C0700X
GACSW0075141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106414OtherLICENSE