Individual
COURTNEY BASCOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 JEFFERSON PARK AVE FL 4, CHARLOTTESVILLE, VA 22903-3363
(434) 924-5367
Mailing address
361 1ST ST N, CHARLOTTESVILLE, VA 22902-5004
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86077676
—
Other
Enumeration date
04/04/2018
Last updated
04/04/2018
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