Provider Demographics
NPI:1992212054
Name:COPPAGE, JOEL CLAYTON (LICSW-S)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:CLAYTON
Last Name:COPPAGE
Suffix:
Gender:M
Credentials:LICSW-S
Other - Prefix:MR
Other - First Name:JOEL
Other - Middle Name:C
Other - Last Name:COPPAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:116 LILY FLAG RD SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803
Mailing Address - Country:US
Mailing Address - Phone:205-440-3602
Mailing Address - Fax:
Practice Address - Street 1:116 LILY FLAGG RD SE
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802
Practice Address - Country:US
Practice Address - Phone:205-440-3602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4314G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker