Provider Demographics
NPI:1104546423
Name:BUCHANAN, CORRINE FAYE (MS, LMHC, LMFT, NCC)
Entity type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:FAYE
Last Name:BUCHANAN
Suffix:
Gender:
Credentials:MS, LMHC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 4TH ST N STE 8198
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4305
Mailing Address - Country:US
Mailing Address - Phone:386-212-0874
Mailing Address - Fax:
Practice Address - Street 1:2601 NW 23RD BLVD APT 134
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-5952
Practice Address - Country:US
Practice Address - Phone:386-212-0874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC9869101YM0800X
FLMT5112106H00000X
FLMH19538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist