Provider Demographics
NPI:1386314391
Name:WILLIAMS, CORTNEY DIANE
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:DIANE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 SPRUCE BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-6453
Mailing Address - Country:US
Mailing Address - Phone:907-651-2373
Mailing Address - Fax:
Practice Address - Street 1:605 HUGHES AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7539
Practice Address - Country:US
Practice Address - Phone:907-347-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)