Provider Demographics
NPI:1326429416
Name:EVANS, COURTNEY TARA (PHD, LCM HC-S, NCC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:TARA
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD, LCM HC-S, NCC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:TARA
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 GLEN OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288
Mailing Address - Country:US
Mailing Address - Phone:336-613-8351
Mailing Address - Fax:
Practice Address - Street 1:718 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288
Practice Address - Country:US
Practice Address - Phone:336-613-8351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11202101Y00000X
NCS-11202101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor