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NPI Code Detail

MEDICARE: COURTNEY ENNIS

MEDICARE: COURTNEY ENNIS
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1780531210
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY ENNIS
Provider Business Mailing Address
First Line : 41528 KALITAN LN
Second Line :
City : LEONARDTOWN
State : MD
Zip : 20650-5855
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 280 STAFFORD RD
Second Line :
City : PRINCE FREDERICK
State : MD
Zip : 20678-3582
Country : US
Telephone Number : 410-535-3079
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2026
Last Update Date : 03/13/2026

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Directions to “ COURTNEY ENNIS ” Practice Location

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