Provider Demographics
NPI:1255014692
Name:ECK COPPOCK, DAPHNE D (MSW)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:D
Last Name:ECK COPPOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:DAPHNE
Other - Middle Name:
Other - Last Name:ECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1057 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2509
Mailing Address - Country:US
Mailing Address - Phone:360-261-7848
Mailing Address - Fax:360-232-8400
Practice Address - Street 1:831 12TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2403
Practice Address - Country:US
Practice Address - Phone:360-998-2349
Practice Address - Fax:360-998-2887
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61480923104100000X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health