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General NPI Number Information
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NPI Number | 1669006953
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Entity Type | Individual
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Provider Name | COURTNEY MCCUBBIN LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 09/18/2022
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Provider Practice Location Address
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Address Line | 924 TYSON ST
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City | BALTIMORE
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State | MD
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Zip | 21201-4811
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Country | US
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Telephone | 443-635-0070
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Fax | 844-225-4606
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Provider Business Mailing Address
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Address Line | 924 TYSON ST
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City | BALTIMORE
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State | MD
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Zip | 21201-4811
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Country | US
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Telephone | 202-870-4732
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC12366
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License Number State | MD
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