Provider Demographics
NPI:1417595992
Name:FARLEY-WHITE, COURTNEY FAITH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:FAITH
Last Name:FARLEY-WHITE
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 1:265 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-6259
Mailing Address - Country:US
Mailing Address - Phone:404-630-0226
Mailing Address - Fax:
Practice Address - Street 1:265 COBBLESTONE LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-6259
Practice Address - Country:US
Practice Address - Phone:404-630-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0034501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical