Provider Demographics
NPI:1336730605
Name:DRAKE, COURTNEY BAXTER (PLPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BAXTER
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5277
Mailing Address - Country:US
Mailing Address - Phone:304-777-8892
Mailing Address - Fax:
Practice Address - Street 1:1277 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1876
Practice Address - Country:US
Practice Address - Phone:304-777-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health