Provider Demographics
NPI:1285451179
Name:MAIER, COURTNEY IRENE (APC, NCC, MED)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:IRENE
Last Name:MAIER
Suffix:
Gender:F
Credentials:APC, NCC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2267
Mailing Address - Country:US
Mailing Address - Phone:706-756-1970
Mailing Address - Fax:
Practice Address - Street 1:401 RIDLEY AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2267
Practice Address - Country:US
Practice Address - Phone:706-756-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health