Provider Demographics
NPI:1366933871
Name:DEAN, COURTNEY JEAN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JEAN
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 PARK SOUTH STATION BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4458
Mailing Address - Country:US
Mailing Address - Phone:941-914-4727
Mailing Address - Fax:
Practice Address - Street 1:1727 RIVER RUN CT
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:NC
Practice Address - Zip Code:27525-7042
Practice Address - Country:US
Practice Address - Phone:704-284-7304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-20-43874103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst