Provider Demographics
NPI:1316254360
Name:COREAS, CHARLIE
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:COREAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 W FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-5143
Mailing Address - Country:US
Mailing Address - Phone:323-759-3464
Mailing Address - Fax:323-759-3427
Practice Address - Street 1:2724 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-5143
Practice Address - Country:US
Practice Address - Phone:323-759-3464
Practice Address - Fax:323-759-3427
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)