Healthcare Provider Details

I. General information

NPI: 1720390115
Provider Name (Legal Business Name): CORTNEY DUNLAP ED.D, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BRAINARD RD STE 105
HARTFORD CT
06114-3202
US

IV. Provider business mailing address

90 BRAINARD RD STE 105
HARTFORD CT
06114-3202
US

V. Phone/Fax

Practice location:
  • Phone: 860-306-9238
  • Fax: 860-470-3286
Mailing address:
  • Phone: 860-306-9238
  • Fax: 860-470-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2466
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number4991824780
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: