Provider Demographics
NPI:1437655156
Name:COOPER, AMBER NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:CARBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:602 RADFORD ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3303
Mailing Address - Country:US
Mailing Address - Phone:540-505-2771
Mailing Address - Fax:
Practice Address - Street 1:602 RADFORD ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3303
Practice Address - Country:US
Practice Address - Phone:540-505-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty