Healthcare Provider Details

I. General information

NPI: 1861730202
Provider Name (Legal Business Name): CORTNEY TINDAL LCAS, LPCA, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORTNEY TEMPLEMAN

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

IV. Provider business mailing address

313 ARGONNE RD
SOUTHPORT NC
28461-7828
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0145
  • Fax: 910-341-5779
Mailing address:
  • Phone: 910-477-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS 2644
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8982
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: