Courtney Elise Wagoner, MA, LCMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

13376 Issued in NC

Practice address

284 Executive Park Dr Ste 100
Concord, NC 28025-1833

Phone

(704) 939-1100

Fax

(704) 939-1173

NPI assigned

May 4, 2011

Last updated

Sep 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Interoperability endpoints

• Direct secure messaging: courtney.sapp.p1@direct.daymarkrecovery.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Daymark Recovery Services, Inc.

  • Multi-Specialty Clinic/Center
  • Concord, NC
  • NPI 1558329243
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1437441862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DR STE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251833",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DR STE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251833",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 N West St",
            "address_2": "Suite 6",
            "address_purpose": "LOCATION",
            "city": "Carlisle",
            "state": "PA",
            "postal_code": "170131447",
            "country_code": "US",
            "telephone_number": "717-386-5237",
            "fax_number": "717-386-5243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "COURTNEY",
        "middle_name": "ELISE",
        "credential": "MA, LCMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-04",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "13376",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "PA",
            "license": "BH001834",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jazmin Wade-Davis, PHARMD
• Amanda Wade, LPC, CRC
• Kristine Vera Wade, AU.D
• Catherine Marie Waggy, D.O.
• Lori Wagner
• Sylvia L Wagoner, ACSW, LCSW
• Wal-Mart Stores East LP (Walmart Pharmacy 10-1027)
• Wal-Mart Stores East LP (WalMart Pharmacy 10-4574)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-6586)
• Wal-Mart Stores East, LP.

• Professional Counselor in Concord, NC
• Providers in Concord, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.