Healthcare Provider Details

I. General information

NPI: 1720429715
Provider Name (Legal Business Name): COURTNEY HUFFMAN LCSW, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S OLD STATESVILLE RD
HUNTERSVILLE NC
28078-9700
US

IV. Provider business mailing address

615 DALE AVE
CHARLOTTE NC
28216-2569
US

V. Phone/Fax

Practice location:
  • Phone: 704-584-9329
  • Fax:
Mailing address:
  • Phone: 828-244-3779
  • Fax: 704-496-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP008121
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: