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General NPI Number Information
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NPI Number | 1023839297
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Entity Type | Individual
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Provider Name | COURTNEY ALLISON VAN KLEECK
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1008 E ASH ST
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City | GOLDSBORO
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State | NC
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Zip | 27530-3808
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Country | US
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Telephone | 252-208-0027
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2469
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City | KINSTON
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State | NC
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Zip | 28502-2469
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Country | US
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Telephone | 252-208-0027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A19950
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License Number State | NC
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