Kenyetta Lovelee Cooper, LSCW, LCAS, CCS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C013964 Issued in NC

Practice address

5416 Raeford Rd Ste a
Fayetteville, NC 28304-3157

Phone

(704) 777-8858

NPI assigned

Jun 13, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC, CO, MA3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Free2Bu Therapeutic Services PLLC

  • Community/Behavioral Health Agency
  • Fayetteville, NC
  • NPI 1295445716

  CO, MA

  Medicare reassignment Authorized official
• Compassionate Counseling Services LLC

  • Mental Health Counselor
  • Rockingham, NC
  • NPI 1689946840

  Addiction (Substance Use Disorder)

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760659200000",
    "number": "1124687058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5416 RAEFORD RD STE A",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043157",
            "telephone_number": "704-939-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5416 RAEFORD RD STE A",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043157",
            "telephone_number": "704-777-8858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1618 Bonforte Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810011676",
            "country_code": "US",
            "telephone_number": "704-777-8858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COOPER",
        "first_name": "KENYETTA",
        "middle_name": "LOVELEE",
        "credential": "LSCW, LCAS, CCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-13",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C013964",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "CCS-21827",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-25591",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chidi E Cooper, CADC
• Elizabeth Mary Cooper, LCSW
• Ellen McLaurin Cooper, FNP
• George Leonard Cooper, M.D.
• Hannah Leigh Cooper
• Madison Cooper
• Sharon P Cooper, MD
• Sydney Cooper
• Judit Andrea Cope, M.D.
• Craig F. Copeland, M.D.

• Clinical Social Worker in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.