Provider Demographics
NPI:1053796102
Name:COURMAN, LAQUITA LASHALL
Entity type:Individual
Prefix:MRS
First Name:LAQUITA
Middle Name:LASHALL
Last Name:COURMAN
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 1:2117 S GLENBURNIE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2280
Mailing Address - Country:US
Mailing Address - Phone:252-633-3855
Mailing Address - Fax:252-633-1548
Practice Address - Street 1:2117 S GLENBURNIE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2280
Practice Address - Country:US
Practice Address - Phone:252-633-3855
Practice Address - Fax:252-633-1548
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0095221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical