Provider Demographics
NPI:1871936864
Name:COOPER, BURNS T (LCSWA)
Entity type:Individual
Prefix:MR
First Name:BURNS
Middle Name:T
Last Name:COOPER
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 S MIAMI BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6281
Mailing Address - Country:US
Mailing Address - Phone:919-806-0509
Mailing Address - Fax:866-820-8694
Practice Address - Street 1:2216 S MIAMI BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6281
Practice Address - Country:US
Practice Address - Phone:919-806-0509
Practice Address - Fax:866-820-8694
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006818101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor