Provider Demographics
NPI:1194150136
Name:HALL, COURTENAY (LCSW)
Entity type:Individual
Prefix:
First Name:COURTENAY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-6622
Mailing Address - Country:US
Mailing Address - Phone:919-892-6614
Mailing Address - Fax:919-289-1490
Practice Address - Street 1:1101 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-6622
Practice Address - Country:US
Practice Address - Phone:919-892-6614
Practice Address - Fax:919-289-1490
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW143801041C0700X
NCP0083511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical