Provider Demographics
NPI:1669006953
Name:MCCUBBIN, COURTNEY (LCPC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MCCUBBIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 TYSON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4811
Mailing Address - Country:US
Mailing Address - Phone:202-870-4732
Mailing Address - Fax:
Practice Address - Street 1:924 TYSON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4811
Practice Address - Country:US
Practice Address - Phone:443-635-0070
Practice Address - Fax:844-225-4606
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12366101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional