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1568005130
DEREK KEVIN COOPER
ELLICOTT CITY, MD
NPI
1568005130
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: MD LGP9653)
Enumeration Date
2019-10-25
Last Update Date
2019-10-25
Business Address
DEREK KEVIN COOPER
5058 DORSEY HALL DR STE 103
ELLICOTT CITY, MD 21042-7850
Phone number: 410-884-9200
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Mailing Address
DEREK KEVIN COOPER
14103 BRAMBLE LN APT 201
LAUREL, MD 20708-1257
Phone number: 240-393-5068
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