Provider Demographics
NPI:1174114524
Name:COOPER, SHENELL (MSW)
Entity type:Individual
Prefix:
First Name:SHENELL
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 CHURCHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5603
Mailing Address - Country:US
Mailing Address - Phone:757-977-9675
Mailing Address - Fax:757-483-8099
Practice Address - Street 1:3001 CHURCHLAND BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5603
Practice Address - Country:US
Practice Address - Phone:757-977-9675
Practice Address - Fax:757-483-8099
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102482101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)