Provider Demographics
NPI:1487909503
Name:COOPER, LANESHIA NATORIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LANESHIA
Middle Name:NATORIA
Last Name:COOPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-0561
Mailing Address - Country:US
Mailing Address - Phone:912-550-8838
Mailing Address - Fax:
Practice Address - Street 1:702 OSSIE DAVIS PKWY
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4656
Practice Address - Country:US
Practice Address - Phone:912-550-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0057431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical