Provider Demographics
NPI:1154566289
Name:COOPER, JOSEPH BENTON (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BENTON
Last Name:COOPER
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 FAIR STONE DR
Mailing Address - Street 2:#201
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5116
Mailing Address - Country:US
Mailing Address - Phone:703-842-7975
Mailing Address - Fax:
Practice Address - Street 1:1908 T ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1276
Practice Address - Country:US
Practice Address - Phone:703-842-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13971101YP2500X
NC2530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional