1902133457 NPI number — MR. COURTNEY MARQUIS ROSEMOND MS, CRC, LCAS, LPC

Table of content: MR. COURTNEY MARQUIS ROSEMOND MS, CRC, LCAS, LPC (NPI 1902133457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902133457 NPI number — MR. COURTNEY MARQUIS ROSEMOND MS, CRC, LCAS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSEMOND
Provider First Name:
COURTNEY
Provider Middle Name:
MARQUIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, CRC, LCAS, LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902133457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7281
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:
27835-7281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-364-2853
Provider Business Mailing Address Fax Number:
252-364-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1206 EVANS ST
Provider Second Line Business Practice Location Address:
SUITE 24
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-364-2853
Provider Business Practice Location Address Fax Number:
252-364-2853
Provider Enumeration Date:
11/04/2009

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: 101YA0400X , with the licence number:  1541 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 8362 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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