Provider Demographics
NPI:1336424456
Name:TURNER-KOPA, CEDRIC (MA, LCAS, CCS)
Entity Type:Individual
Prefix:MR
First Name:CEDRIC
Middle Name:
Last Name:TURNER-KOPA
Suffix:
Gender:M
Credentials:MA, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 CASTLE HAYNE RD BLDG C
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-8859
Mailing Address - Country:US
Mailing Address - Phone:910-251-6644
Mailing Address - Fax:910-251-6643
Practice Address - Street 1:1611 CASTLE HAYNE RD BLDG C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-8859
Practice Address - Country:US
Practice Address - Phone:910-251-6644
Practice Address - Fax:910-251-6643
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21196101YA0400X
NC3439A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)