Provider Demographics
NPI:1528204070
Name:DAVIS, COURTNEY JORGENSEN (MS)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:JORGENSEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 759194
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9194
Mailing Address - Country:US
Mailing Address - Phone:828-697-4187
Mailing Address - Fax:828-697-4488
Practice Address - Street 1:1430 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-2302
Practice Address - Country:US
Practice Address - Phone:828-697-4187
Practice Address - Fax:828-697-4488
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104102Medicaid