Provider Demographics
NPI:1659888949
Name:SURRETT, COURTNEY (LPCA, NCC, MA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SURRETT
Suffix:
Gender:F
Credentials:LPCA, NCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10814 KEMPTOWN SQUARE SQ N
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-5042
Mailing Address - Country:US
Mailing Address - Phone:704-307-9007
Mailing Address - Fax:
Practice Address - Street 1:32 HICKORY STREET
Practice Address - Street 2:
Practice Address - City:BADIN
Practice Address - State:NC
Practice Address - Zip Code:28009
Practice Address - Country:US
Practice Address - Phone:704-463-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional