Provider Demographics
NPI:1891992277
Name:WHITE, COURTNEY CAUDLE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:CAUDLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-4911
Mailing Address - Country:US
Mailing Address - Phone:828-322-4941
Mailing Address - Fax:828-322-4931
Practice Address - Street 1:263 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4911
Practice Address - Country:US
Practice Address - Phone:828-322-4941
Practice Address - Fax:828-322-4931
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6947101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103883Medicaid
3224037OtherCIGNA
56162OtherMEDCOST
11945552OtherCAQH NUMBER
151MEOtherBLUE CROSS/BLUE SHIELD
2234504OtherCOMPSYCH
9736312OtherAETNA
467889OtherMHN