Provider Demographics
NPI:1295016095
Name:HAMILTON, COURTNEY HOLLEY (LCMHCS, LCAS, CCS)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:HOLLEY
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCMHCS, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 WINTERBELL DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-6998
Mailing Address - Country:US
Mailing Address - Phone:704-245-3016
Mailing Address - Fax:
Practice Address - Street 1:542 WILLIAMSON RD STE 4
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9138
Practice Address - Country:US
Practice Address - Phone:704-245-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7674101YP2500X, 101YP2500X
NCS7674101Y00000X
NC3130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
167PROtherBCBS