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General NPI Number Information
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NPI Number | 1114353257
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Entity Type | Individual
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Provider Name | COURTNEY THOMAS LCSW, LCASA
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Gender | Female
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 351 WAGONER DR STE 318
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4739
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Country | US
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Telephone | 859-420-8043
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Fax |
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Provider Business Mailing Address
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Address Line | 910 HOPE MILLS RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4243
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Country | US
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Telephone | 910-302-8290
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-16017
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C009768
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License Number State | NC
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