Individual
JACQUELYN MARIE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
LADAC II
Contact information
Practice address
1510 STUART RD NE STE 101, CLEVELAND, TN 37312-5869
(423) 790-4906
Mailing address
1809 FOREST RIDGE DR SW, CLEVELAND, TN 37311-7321
(423) 599-2597
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1730
TN
Other
Enumeration date
06/21/2025
Last updated
06/21/2025
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