Organization Active NPI

Cooper Counseling and Therapy Services, PLLC

  • Community/Behavioral Health Agency
  • Charlotte, NC
National Provider Identifier
1265104434
Registry record updated Jan 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COOPER COUNSELING AND THERAPY SERVICES, PLLC
Practice address
6047 Tyvola Glen Cir Ste 211
Charlotte, NC 28217-6437
Phone
(980) 900-9574
Fax
(704) 780-1066
NPI assigned
Oct 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2025

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

Authorized official

Name
Ms. Carman Vatrell Cooper, LCSWNPI 1972950400
Title
Owner
Phone
(980) 900-9574

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Community/Behavioral Health Agency 251S00000X Primary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X

Addresses

Primary practice location

6047 Tyvola Glen Cir Ste 211
Charlotte, NC 28217-6437

Mailing address

10109 Glenburn LN
Charlotte, NC 28278-6001
Phone (980) 900-9574

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230720002786 NC Part B Supplier - Clinic/Group Practice 6103286273 Receives reassigned benefits from 1 practitioner
Practice locations: Rock Hill, SC; Charlotte, NC
O20240104000595 SC Part B Supplier - Clinic/Group Practice 6103286273 Receives reassigned benefits from 1 practitioner
Practice locations: Rock Hill, SC

National Provider Directory

National Provider Directory

Locations

6047 Tyvola Glen Cir
Ste 211
Charlotte, NC 28217
Phone (980) 900-9574

1327 Crawford Rd
Rock Hill, SC 29730
Phone (980) 900-9574

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738022400000",
    "number": "1265104434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10109 GLENBURN LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282786001",
            "telephone_number": "980-900-9574",
            "fax_number": "704-780-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6047 TYVOLA GLEN CIR STE 211",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282176437",
            "telephone_number": "980-900-9574",
            "fax_number": "704-780-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPER COUNSELING AND THERAPY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-05",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "CARMAN",
        "authorized_official_middle_name": "VATRELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "980-900-9574",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.