Provider Demographics
NPI:1386511335
Name:FULLWOOD, COURTNEY DARNELL (LMSW)
Entity type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:DARNELL
Last Name:FULLWOOD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10106 MADRONAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3164
Mailing Address - Country:US
Mailing Address - Phone:240-855-5032
Mailing Address - Fax:
Practice Address - Street 1:10705 CHARTER DR STE 430
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2870
Practice Address - Country:US
Practice Address - Phone:301-259-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD33382104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker