Provider Demographics
NPI:1104023746
Name:SAMWEL, CORINE SIMONE (PHD)
Entity type:Individual
Prefix:DR
First Name:CORINE
Middle Name:SIMONE
Last Name:SAMWEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 MAHAN DR
Mailing Address - Street 2:ST. 5
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5463
Mailing Address - Country:US
Mailing Address - Phone:850-552-0691
Mailing Address - Fax:850-656-8969
Practice Address - Street 1:2898 MAHAN DR
Practice Address - Street 2:ST. 5
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5463
Practice Address - Country:US
Practice Address - Phone:850-552-0691
Practice Address - Fax:850-656-8969
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor