Provider Demographics
NPI:1841518149
Name:WHITE, COURTNEY BLYTHE WALTERS (LCMHCS, CCMHC, NCC)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:BLYTHE WALTERS
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCMHCS, CCMHC, NCC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:BLYTHE
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4801 GLENWOOD AVENUE
Mailing Address - Street 2:SUITE 200 #827
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612
Mailing Address - Country:US
Mailing Address - Phone:910-812-1843
Mailing Address - Fax:910-407-9057
Practice Address - Street 1:4801 GLENWOOD AVENUE
Practice Address - Street 2:SUITE 200 #827
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:910-812-1843
Practice Address - Fax:910-417-9057
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7375101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health