Individual
CHANELLE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22593 THREE NOTCH RD, CALIFORNIA, MD 20619-3202
(301) 862-2505
(301) 862-2548
Mailing address
22593 THREE NOTCH RD, CALIFORNIA, MD 20619-3202
(301) 862-2505
(301) 862-2548
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/18/2023
Last updated
08/18/2023
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