Provider Demographics
NPI:1982044046
Name:COOPER, CARL RISPERS (MRC, CRC, LCMHC, CBH)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:RISPERS
Last Name:COOPER
Suffix:
Gender:M
Credentials:MRC, CRC, LCMHC, CBH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 PHAR LAP DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5751
Mailing Address - Country:US
Mailing Address - Phone:704-292-0834
Mailing Address - Fax:
Practice Address - Street 1:1110 PHAR LAP DR
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5751
Practice Address - Country:US
Practice Address - Phone:704-807-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC941101Y00000X
NC9141101YP2500X, 101YM0800X
00113409225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00113409OtherCERTIFIED REHABILITATION COUNSELOR
NC9141OtherLICENSED PROFESSIONAL MENTAL HEALTH COUNSELOR