Provider Demographics
NPI:1669158481
Name:COURMAN, ANTHONY DEONDRAY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DEONDRAY
Last Name:COURMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S GLENBURNIE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2610
Mailing Address - Country:US
Mailing Address - Phone:252-336-3646
Mailing Address - Fax:252-421-9200
Practice Address - Street 1:1425 S GLENBURNIE RD STE 2
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2610
Practice Address - Country:US
Practice Address - Phone:252-336-3646
Practice Address - Fax:252-421-9200
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0191531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty