Basic Information
| Provider Information | |||||||||
| NPI: | 1043606460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILL | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | TUCKFIELD | ||||||||
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| Credential: | M.A., LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 284 EXECUTIVE PARK DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
| FaxNumber: | 7049391173 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 BALFOUR DR | ||||||||
| Address2: | |||||||||
| City: | ARCHDALE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272633117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364310700 | ||||||||
| FaxNumber: | 3364310762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2015 | ||||||||
| LastUpdateDate: | 05/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | A11055 | NC | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 11055 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.