Provider Demographics
NPI:1275074908
Name:WILLIAMS, COURTNEY (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 DIAMOND SPRINGS RD STE 503
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3645
Mailing Address - Country:US
Mailing Address - Phone:757-656-1665
Mailing Address - Fax:
Practice Address - Street 1:1300 DIAMOND SPRINGS RD STE 503
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-3645
Practice Address - Country:US
Practice Address - Phone:757-656-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174666363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health