Doctor Name: | MRS. LACEY MICHELLE CORL |
NPI Number: | 1871639377 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LISW |
License Number: | I 1201500 |
Business Practice Address: | 203 Promenade Dr Swanton, OH - 435581428 |
Business Phone Number: | 4198740274 |
Business Fax Number: | 4198749960 |
Mailing Address: | 203 Promenade Dr, SWANTON |
State: | OH |
Postal Code: | 435581428 |
Phone Number: | 4198740274 |
Fax Number: | 4198749960 |
NPI Enumeration Date: | 01/30/2007 |
NPI Last Update Date: | 02/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | I 1201500 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |