Provider Demographics
NPI:1134518400
Name:AVVAMPATO, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:AVVAMPATO
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 1:1470 CIVIC CT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5290
Mailing Address - Country:US
Mailing Address - Phone:925-680-0222
Mailing Address - Fax:
Practice Address - Street 1:1470 CIVIC CT
Practice Address - Street 2:SUITE 110
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5290
Practice Address - Country:US
Practice Address - Phone:925-680-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor