Provider Demographics
NPI:1063064574
Name:COURTNEY, SARAH (CCLS (#19460))
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:CCLS (#19460)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 ABBEY HILL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-1912
Mailing Address - Country:US
Mailing Address - Phone:757-303-7314
Mailing Address - Fax:
Practice Address - Street 1:508 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5110
Practice Address - Country:US
Practice Address - Phone:704-412-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11076A101YM0800X
NC19460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty