Provider Demographics
NPI:1114353257
Name:THOMAS, COURTNEY (LCSW, LCASA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 HOPE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4243
Mailing Address - Country:US
Mailing Address - Phone:910-302-8290
Mailing Address - Fax:
Practice Address - Street 1:351 WAGONER DR STE 318
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4739
Practice Address - Country:US
Practice Address - Phone:859-420-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-16017101YA0400X
NCC0097681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)