Provider Demographics
NPI:1427874353
Name:WISE, CORRINE (LPC)
Entity type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:
Last Name:WISE
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 1:10370 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:PA
Mailing Address - Zip Code:16111-1344
Mailing Address - Country:US
Mailing Address - Phone:814-853-2358
Mailing Address - Fax:
Practice Address - Street 1:39 HADLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1239
Practice Address - Country:US
Practice Address - Phone:814-550-4969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional