Provider Demographics
NPI:1720175516
Name:COPELAND, CAROL M (PHD, LCSW, BCD, ACSW)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:COPELAND
Suffix:
Gender:F
Credentials:PHD, LCSW, BCD, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 OLIVIA VW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4305
Mailing Address - Country:US
Mailing Address - Phone:703-944-1854
Mailing Address - Fax:
Practice Address - Street 1:WILFORD HALL AMBULATORY SURG CENTER
Practice Address - Street 2:1100 WILFORD HALL LOOP
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0155561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical