Healthcare Provider Details

I. General information

NPI: 1730016171
Provider Name (Legal Business Name): COURTNEY NISHNICK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 LYNNHAVEN PKWY STE 200
VIRGINIA BEACH VA
23452-7325
US

IV. Provider business mailing address

1832 KEMPSVILLE RD STE 112 #204
VIRGINIA BEACH VA
23464-6861
US

V. Phone/Fax

Practice location:
  • Phone: 757-652-7213
  • Fax:
Mailing address:
  • Phone: 757-301-4644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710103701
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701016178
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016178
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: