Provider Demographics
NPI:1194237958
Name:BOSTON, CORRONA SELENA (LPC AND ATR)
Entity type:Individual
Prefix:MS
First Name:CORRONA
Middle Name:SELENA
Last Name:BOSTON
Suffix:
Gender:F
Credentials:LPC AND ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17309 NEWTON CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3308
Mailing Address - Country:US
Mailing Address - Phone:240-938-1092
Mailing Address - Fax:
Practice Address - Street 1:3001 BLADENSBURG RD NE STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2235
Practice Address - Country:US
Practice Address - Phone:202-635-3577
Practice Address - Fax:202-635-0906
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health