Provider Demographics
NPI:1114798469
Name:BUSHNELL, COURTNEY B (LCSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:B
Last Name:BUSHNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 20TH ST S APT 609
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3624
Mailing Address - Country:US
Mailing Address - Phone:801-835-1349
Mailing Address - Fax:
Practice Address - Street 1:220 20TH ST S APT 609
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3624
Practice Address - Country:US
Practice Address - Phone:801-835-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12388305-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical