Healthcare Provider Details

I. General information

NPI: 1295328136
Provider Name (Legal Business Name): COURTNEY HANNAH CASE LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 FAIRVIEW RD
CHARLOTTE NC
28210-3321
US

IV. Provider business mailing address

6633 FAIRVIEW RD
CHARLOTTE NC
28210-3321
US

V. Phone/Fax

Practice location:
  • Phone: 704-336-1264
  • Fax: 704-442-4162
Mailing address:
  • Phone: 704-336-1264
  • Fax: 704-442-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number12257A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: