Provider Demographics
NPI:1720542319
Name:CONLEY, COURTNEY E A (EDD, LCPC, NCC, ACS)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:E A
Last Name:CONLEY
Suffix:
Gender:F
Credentials:EDD, LCPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6370 GRANT CHAPMAN DR
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3524
Mailing Address - Country:US
Mailing Address - Phone:814-366-1072
Mailing Address - Fax:
Practice Address - Street 1:5 N MAPLE AVE STE 202
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3744
Practice Address - Country:US
Practice Address - Phone:814-366-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4317101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional