Provider Demographics
NPI:1023839297
Name:VAN KLEECK, COURTNEY ALLISON
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ALLISON
Last Name:VAN KLEECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2469
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28502-2469
Mailing Address - Country:US
Mailing Address - Phone:252-208-0027
Mailing Address - Fax:
Practice Address - Street 1:1008 E ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3808
Practice Address - Country:US
Practice Address - Phone:252-208-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19950101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health