Provider Demographics
NPI:1235689241
Name:COURSON, ANNAH (LPC)
Entity Type:Individual
Prefix:
First Name:ANNAH
Middle Name:
Last Name:COURSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-3201
Mailing Address - Country:US
Mailing Address - Phone:334-712-2720
Mailing Address - Fax:
Practice Address - Street 1:1053 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-3201
Practice Address - Country:US
Practice Address - Phone:334-712-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional