Provider Demographics
NPI:1013673946
Name:COURTNAY MECCA NUTRITION, LLC
Entity type:Organization
Organization Name:COURTNAY MECCA NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MECCA
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, LDN
Authorized Official - Phone:443-906-1345
Mailing Address - Street 1:301 ARUNDEL BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3311
Mailing Address - Country:US
Mailing Address - Phone:443-906-1345
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HIGHWAY
Practice Address - Street 2:SUITE 200, #1140
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:443-906-1345
Practice Address - Fax:443-227-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty