MEDICARE: MRS. COURTENAY CLAIRE MONFORE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	COURTENAY01	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1215239447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTENAY CLAIRE MONFORE LPC

Provider Business Mailing Address
First Line	:	2813 COLTSGATE RD STE 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-3585
Country	:	US
Telephone Number	:	541-331-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	2813 COLTSGATE ROAD, SUITE 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211
Country	:	US
Telephone Number	:	704-741-2082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	01/06/2020

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