1508562992 NPI number — MRS. COURTNEY DIANNE OWENS LCSWA

Table of content: MRS. COURTNEY DIANNE OWENS LCSWA (NPI 1508562992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508562992 NPI number — MRS. COURTNEY DIANNE OWENS LCSWA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWENS
Provider First Name:
COURTNEY
Provider Middle Name:
DIANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
DIANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508562992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
523 SPRING FOREST RD APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27834-7232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-347-6856
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 SPRING FOREST RD APT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-7232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-347-6856
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  P015068 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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