Active NPI
Courtney Haynes Petty, LCSWA
- Clinical Social Worker
- Lincolnton, NC
National Provider Identifier
1659056174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- PO18662
- Practice address
- 301 Jeb Seagle Dr
Lincolnton, NC 28092-2168 - Phone
- (704) 736-1626
- NPI assigned
- Jun 21, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | PO18662 | NC | Primary |
Addresses
Primary practice location
301 Jeb Seagle Dr
Lincolnton, NC 28092-2168
Mailing address
200 E 2ND Ave
Gastonia, NC 28052-4358
Phone (704) 874-1900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PO18662 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703721600000",
"number": "1659056174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E 2ND AVE",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280524358",
"telephone_number": "704-874-1900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 JEB SEAGLE DR",
"city": "LINCOLNTON",
"state": "NC",
"postal_code": "280922168",
"telephone_number": "704-736-1626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "COURTNEY",
"middle_name": "HAYNES",
"credential": "LCSWA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-21",
"last_updated": "2023-12-28",
"certification_date": "2023-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "PO18662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincolnton, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.