Provider Demographics
NPI:1215268008
Name:HOWARD, COURTNEY LYNN (LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LYNN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 TEA OLIVE PL
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-8105
Mailing Address - Country:US
Mailing Address - Phone:864-663-2664
Mailing Address - Fax:864-688-2766
Practice Address - Street 1:110 HOSPITAL DR STE B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3226
Practice Address - Country:US
Practice Address - Phone:864-663-2664
Practice Address - Fax:864-688-2766
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1352Medicaid