Provider Demographics
NPI:1629385216
Name:HALL, COURTNEY K (MS,MED,NCC, LCPC)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:K
Last Name:HALL
Suffix:
Gender:F
Credentials:MS,MED,NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21793-8112
Mailing Address - Country:US
Mailing Address - Phone:240-285-5276
Mailing Address - Fax:
Practice Address - Street 1:231 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8112
Practice Address - Country:US
Practice Address - Phone:240-285-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3223051 00Medicaid