Provider Demographics
NPI:1912570508
Name:CRAVEN, COURTNEY JUDITH (LCMHCA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JUDITH
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 NORTHEAST DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7438
Mailing Address - Country:US
Mailing Address - Phone:704-896-7776
Mailing Address - Fax:
Practice Address - Street 1:903 NORTHEAST DR STE 201
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7438
Practice Address - Country:US
Practice Address - Phone:704-896-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health