Provider Demographics
NPI:1023708302
Name:COOPER, KEARA KATHERINE (LCSW)
Entity type:Individual
Prefix:
First Name:KEARA
Middle Name:KATHERINE
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 1:109 HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6435
Mailing Address - Country:US
Mailing Address - Phone:757-912-2409
Mailing Address - Fax:
Practice Address - Street 1:11817 CANON BLVD STE 304
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4516
Practice Address - Country:US
Practice Address - Phone:757-912-2409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040152541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical