Provider Demographics
NPI:1982044046
Name:COOPER, CARL RISPERS (MRC, CRC,LPC)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:RISPERS
Last Name:COOPER
Suffix:
Gender:M
Credentials:MRC, CRC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 PHAR LAP DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5751
Mailing Address - Country:US
Mailing Address - Phone:704-807-3044
Mailing Address - Fax:
Practice Address - Street 1:1110 PHAR LAP DR
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5751
Practice Address - Country:US
Practice Address - Phone:704-807-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00113409101YP2500X
NC9141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
00113409OtherCERTIFIED REHABILITATION COUNSELOR
NC9141OtherLICENSED PROFESSIONAL MENTAL HEALTH COUNSELOR