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1255590956
CHARLES DWAYNE COOPER
CANOGA PARK, CA
NPI
1255590956
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2008-06-06
Last Update Date
2008-06-06
Business Address
-- CHARLES DWAYNE COOPER
22030 SHERMAN WAY
CANOGA PARK, CA 91303-1855
Phone number: 818-340-0230
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Mailing Address
-- CHARLES DWAYNE COOPER
676 S CENTRAL AVE
LOS ANGELES, CA 90021-1039
Phone number:
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