Doctor Name: | MRS. COURTNEY LYNN SURIGAO |
NPI Number: | 1962675777 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | 4960 |
Business Practice Address: | 1041 Old Ocean Hwy Bolivia, NC - 284228584 |
Business Phone Number: | 9107547908 |
Business Fax Number: | 9107993313 |
Mailing Address: | 1041 Old Ocean Hwy, BOLIVIA |
State: | NC |
Postal Code: | 284228584 |
Phone Number: | 9107547908 |
Fax Number: | 9107993313 |
NPI Enumeration Date: | 04/12/2008 |
NPI Last Update Date: | 08/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 4960 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |