Individual
MR. ADDISON COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1881 BUSINESS CENTER DR STE 10A, SAN BERNARDINO, CA 92408-3438
(909) 890-2381
Mailing address
1881 BUSINESS CENTER DR STE 10A, SAN BERNARDINO, CA 92408-3438
(909) 890-2381
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
2012015566
MO
1041C0700X
Clinical Social Worker
Primary
27804
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012015566
LICENSE
MO
01
—
27804
LICENSE
CA
Enumeration date
12/20/2012
Last updated
01/27/2017
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