Provider Demographics
NPI:1639821499
Name:DEFLANDERS-GRIFFIN, COURTNEY SIMONE (LPC, NCC, NSCS)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:SIMONE
Last Name:DEFLANDERS-GRIFFIN
Suffix:
Gender:F
Credentials:LPC, NCC, NSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13660 TARA HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2331
Mailing Address - Country:US
Mailing Address - Phone:228-596-5418
Mailing Address - Fax:
Practice Address - Street 1:13660 TARA HILLS CIR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2331
Practice Address - Country:US
Practice Address - Phone:228-596-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional