Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kenyetta Lovelee Cooper, LSCW, LCAS, CCS

Individual provider Clinical Social Worker · NPI 1124687058

Kenyetta Lovelee Cooper, LSCW, LCAS, CCS is a Clinical Social Worker in Fayetteville, North Carolina. Qualified in 2019, 7 years ago. Works from 2 locations. Licensed in North Carolina.

Years since qualifying
7
Licensed in
NC
In the registry since
2019
Specialties on file
3
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Practice location Address checks out

5416 Raeford Rd Ste A
Fayetteville, NC 28304-3157
Phone: (704) 777-8858
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1618 Bonforte Blvd Ste B, Pueblo, CO 81001-1676 — (704) 777-8858

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence C013964 (NC)
Clinical Social Worker Taxonomy 1041C0700X · Licence CCS-21827 (NC)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence LCAS-25591 (NC)

Record details

NPI number1124687058
Entity typeIndividual (Type 1)
GenderFemale
Credentials LSCW , LCAS , CCS
Sole proprietorNo
NPI enumeratedJune 13, 2019
Last updated in NPPESOctober 17, 2025
Certification dateOctober 17, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

Other providers in Fayetteville