Healthcare Provider Details

I. General information

NPI: 1417848581
Provider Name (Legal Business Name): COURTNEY VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HIGHWAY 105 EXT STE 100
BOONE NC
28607-4291
US

IV. Provider business mailing address

PO BOX 1490
BOONE NC
28607-0682
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-7311
  • Fax: 828-264-7907
Mailing address:
  • Phone: 828-262-3886
  • Fax: 833-665-5329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21424
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: