Provider Demographics
NPI:1548428162
Name:CANTRELL, COURTNEY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:M
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 KELLY RD # 204
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-9572
Mailing Address - Country:US
Mailing Address - Phone:919-886-4325
Mailing Address - Fax:
Practice Address - Street 1:5448 APEX PEAKWAY # 201
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3924
Practice Address - Country:US
Practice Address - Phone:919-886-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4291103TC0700X
NC3861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP81155Medicaid