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General NPI Number Information
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NPI Number | 1588709760
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Entity Type | Individual
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Provider Name | COURTNEY WILLIAM RAY LCSW C
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 10784 HICKORY RIDGE RD
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City | COLUMBIA
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State | MD
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Zip | 21044-3646
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Country | US
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Telephone | 410-992-7288
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Fax | 410-997-2880
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Provider Business Mailing Address
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Address Line | 4500 GROSS MILL RD
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City | HAMPSTEAD
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State | MD
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Zip | 21074-2519
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Country | US
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Telephone | 410-374-4021
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 11545
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License Number State | MD
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