Doctor Name: | MRS. AMANDA COLUNGA CORKILL |
NPI Number: | 1295871077 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 18537 |
Business Practice Address: | 1001 N Bonham St Ste 8 San Benito, TX - 785865309 |
Business Phone Number: | 9563992740 |
Business Fax Number: | |
Mailing Address: | 1001 N Bonham St Ste 8, SAN BENITO |
State: | TX |
Postal Code: | 785865309 |
Phone Number: | 9563992740 |
Fax Number: | |
NPI Enumeration Date: | 01/29/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 18537 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |