Provider Demographics
NPI:1124770706
Name:COREY, DIANE ALEXIS (LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ALEXIS
Last Name:COREY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W PENN AVE
Mailing Address - Street 2:
Mailing Address - City:ROBESONIA
Mailing Address - State:PA
Mailing Address - Zip Code:19551-1504
Mailing Address - Country:US
Mailing Address - Phone:610-750-9135
Mailing Address - Fax:
Practice Address - Street 1:140 W PENN AVE
Practice Address - Street 2:
Practice Address - City:ROBESONIA
Practice Address - State:PA
Practice Address - Zip Code:19551-1504
Practice Address - Country:US
Practice Address - Phone:484-797-1372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007140101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor