Provider Demographics
NPI:1265104434
Name:COOPER COUNSELING AND THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:COOPER COUNSELING AND THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMAN
Authorized Official - Middle Name:VATRELL
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:980-900-9574
Mailing Address - Street 1:10109 GLENBURN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6001
Mailing Address - Country:US
Mailing Address - Phone:980-900-9574
Mailing Address - Fax:704-780-1066
Practice Address - Street 1:6047 TYVOLA GLEN CIR STE 211
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-6437
Practice Address - Country:US
Practice Address - Phone:980-900-9574
Practice Address - Fax:704-780-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty