Provider Demographics
NPI:1104057850
Name:WORDEN, COREY JAMES (MA, LCPC)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:JAMES
Last Name:WORDEN
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13841 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2891
Mailing Address - Country:US
Mailing Address - Phone:630-880-0221
Mailing Address - Fax:
Practice Address - Street 1:24012 W RENWICK RD STE 204A
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8733
Practice Address - Country:US
Practice Address - Phone:815-676-4688
Practice Address - Fax:815-676-4498
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007958101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor