Provider Demographics
NPI:1295126746
Name:SOPER, ANNA MILLER (LCAS, LCMHCA)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MILLER
Last Name:SOPER
Suffix:
Gender:F
Credentials:LCAS, LCMHCA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:BROOKE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAS, LPCA
Mailing Address - Street 1:311 WILLIAMSON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5967
Mailing Address - Country:US
Mailing Address - Phone:704-756-0058
Mailing Address - Fax:704-873-6647
Practice Address - Street 1:311 WILLIAMSON RD STE 103
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5967
Practice Address - Country:US
Practice Address - Phone:704-756-0058
Practice Address - Fax:704-973-9588
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21123101YA0400X
NCA15487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)