Individual
DALE PHILLIP COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CACI, CACII
Contact information
Practice address
510 E CAROLINA AVE, HARTSVILLE, SC 29550-4312
(843) 332-4156
Mailing address
1623 SHADY OAK LN, FLORENCE, SC 29506-9112
(843) 669-2496
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0909044
SC
Other
Enumeration date
09/29/2010
Last updated
09/29/2010
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