Provider Demographics
NPI:1083084818
Name:PHELON LO, CORTNEY (PHD)
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:PHELON LO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 E KING ST
Mailing Address - Street 2:#1582
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-0107
Mailing Address - Country:US
Mailing Address - Phone:919-225-5921
Mailing Address - Fax:
Practice Address - Street 1:241 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2521
Practice Address - Country:US
Practice Address - Phone:919-225-5921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health