MEDICARE: COURTNEY E RUDD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C019636	NC

General Provider Information

NPI Number	:	1801571138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY E RUDD LCSW

Provider Business Mailing Address
First Line	:	3950 FAIRSTED DR APT 260
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-4546
Country	:	US
Telephone Number	:	336-684-8099
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 GREEN RD STE 103
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-2848
Country	:	US
Telephone Number	:	919-872-6220
Fax Number	:	919-872-6223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	02/18/2026

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