Individual
MRS. TRACY IRENETTE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS A
Contact information
Practice address
130 JONES RD, ROCKY MOUNT, NC 27804
(252) 443-0480
Mailing address
1261 KATHERINE TRL, ROCKY MOUNT, NC 27804-9362
(252) 822-1243
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15432
NC
Other
Enumeration date
05/22/2018
Last updated
06/01/2018
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