Provider Demographics
NPI:1952857278
Name:SMITH, COURTNEY JEANETTE
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:JEANETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:JEANETTE
Other - Last Name:SEIDLITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:821 SPYDERCO RD.
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29527-2900
Mailing Address - Country:US
Mailing Address - Phone:843-655-1332
Mailing Address - Fax:
Practice Address - Street 1:164 WACCAMAW MEDICAL PARK DR.
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:843-347-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor