Healthcare Provider Details

I. General information

NPI: 1386620714
Provider Name (Legal Business Name): MARY LYNNE COURTNEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 CHAPEL HILL RD
RALEIGH NC
27607-5043
US

IV. Provider business mailing address

PO BOX 162
CARY NC
27512-0162
US

V. Phone/Fax

Practice location:
  • Phone: 919-415-0050
  • Fax: 919-467-0979
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2710
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: