Provider Demographics
NPI:1285119438
Name:COOPER, SAMANTHA (LISW-CP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 VANGUARD ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9791
Mailing Address - Country:US
Mailing Address - Phone:843-701-2499
Mailing Address - Fax:
Practice Address - Street 1:108 PALMETTO PARK BLVD STE D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7969
Practice Address - Country:US
Practice Address - Phone:843-701-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12768104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker