Provider Demographics
NPI:1669005062
Name:STOKES, KOURTLAND
Entity Type:Individual
Prefix:
First Name:KOURTLAND
Middle Name:
Last Name:STOKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 LAWNDALE DR APT H
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3452
Mailing Address - Country:US
Mailing Address - Phone:336-681-0225
Mailing Address - Fax:
Practice Address - Street 1:310 MURPHY DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-2100
Practice Address - Country:US
Practice Address - Phone:336-224-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)