Provider Demographics
NPI:1235657701
Name:COOPER, BRITAINEY (MA, EDS, NCSP)
Entity type:Individual
Prefix:
First Name:BRITAINEY
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA, EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MOTTS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7854
Mailing Address - Country:US
Mailing Address - Phone:304-377-6252
Mailing Address - Fax:
Practice Address - Street 1:2601 IRON GATE DR STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6624
Practice Address - Country:US
Practice Address - Phone:910-202-9113
Practice Address - Fax:910-202-9289
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46326103TS0200X
NC6627103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6627OtherNC PSYCH BOARD LICENSE