Provider Demographics
NPI:1841907441
Name:ULLAH, COURTNEY (MSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ULLAH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 W STATE ROAD 426 STE 1051
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4516
Mailing Address - Country:US
Mailing Address - Phone:407-365-1199
Mailing Address - Fax:
Practice Address - Street 1:2441 W STATE ROAD 426 STE 1051
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4516
Practice Address - Country:US
Practice Address - Phone:407-365-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW17858104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker