Provider Demographics
NPI:1780202671
Name:COURTNEY, JENNIFER (CAC-AD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 BRASS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1213
Mailing Address - Country:US
Mailing Address - Phone:410-273-9700
Mailing Address - Fax:
Practice Address - Street 1:1361 BRASS MILL RD STE A
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1213
Practice Address - Country:US
Practice Address - Phone:410-273-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)