Provider Demographics
NPI:1336745231
Name:COOPER, DAMEKICA N (CNA)
Entity Type:Individual
Prefix:
First Name:DAMEKICA
Middle Name:N
Last Name:COOPER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14120 15 MILE RD APT 110
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-5561
Mailing Address - Country:US
Mailing Address - Phone:313-627-1868
Mailing Address - Fax:
Practice Address - Street 1:20200 VEACH ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3218
Practice Address - Country:US
Practice Address - Phone:586-420-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230005622360101103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service