Provider Demographics
NPI:1427340876
Name:COOPER, TEAWANNA (LCSWR QMHP-A/C MED)
Entity type:Individual
Prefix:MS
First Name:TEAWANNA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSWR QMHP-A/C MED
Other - Prefix:
Other - First Name:THRIVEVA
Other - Middle Name:
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWR QMHP-A/C MED
Mailing Address - Street 1:900 COMMONWEALTH PL STE 200
Mailing Address - Street 2:392
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4530
Mailing Address - Country:US
Mailing Address - Phone:757-788-3033
Mailing Address - Fax:
Practice Address - Street 1:900 COMMONWEALTH PL STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4530
Practice Address - Country:US
Practice Address - Phone:757-788-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
VA0732009862101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA853474580OtherIRS