Provider Demographics
NPI:1790541399
Name:WHITE, COURTNEY (AS, RBA, BS)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:AS, RBA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12086 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-7902
Mailing Address - Country:US
Mailing Address - Phone:304-936-1984
Mailing Address - Fax:
Practice Address - Street 1:12086 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-7902
Practice Address - Country:US
Practice Address - Phone:304-936-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator