Provider Demographics
NPI:1588723050
Name:COPP, DANICA BEAULAC (LICSW/MA LCSW/VA)
Entity type:Individual
Prefix:MRS
First Name:DANICA
Middle Name:BEAULAC
Last Name:COPP
Suffix:
Gender:F
Credentials:LICSW/MA LCSW/VA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13649 OFFICE PL
Mailing Address - Street 2:102
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4215
Mailing Address - Country:US
Mailing Address - Phone:703-670-5738
Mailing Address - Fax:703-670-8213
Practice Address - Street 1:13649 OFFICE PL
Practice Address - Street 2:102
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4215
Practice Address - Country:US
Practice Address - Phone:703-670-5738
Practice Address - Fax:703-670-8213
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121051041C0700X
VA09040067641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical