Provider Demographics
NPI:1982374401
Name:COOPER, ARDEN MEKELLE
Entity Type:Individual
Prefix:
First Name:ARDEN
Middle Name:MEKELLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 26TH ST NW APT 1304
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2071
Mailing Address - Country:US
Mailing Address - Phone:571-271-8851
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PSYCHOLOGY
Practice Address - Street 2:GEORGIA STATE UNIVERSITY URBAN LIFE BUILDING
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:571-271-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program