Provider Demographics
NPI:1275204356
Name:PERNICK, COURTNEY BETH
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BETH
Last Name:PERNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:BETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 REMSON CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-3508
Mailing Address - Country:US
Mailing Address - Phone:434-923-8252
Mailing Address - Fax:434-282-2180
Practice Address - Street 1:3500 REMSON CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-3508
Practice Address - Country:US
Practice Address - Phone:434-923-8252
Practice Address - Fax:434-282-2180
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-15-20113103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst