Provider Demographics
NPI:1720865207
Name:NADEAU, COREY M
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:M
Last Name:NADEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 PRESERVATION CIR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-0685
Mailing Address - Country:US
Mailing Address - Phone:850-252-0241
Mailing Address - Fax:
Practice Address - Street 1:4145 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-5400
Practice Address - Country:US
Practice Address - Phone:706-869-7373
Practice Address - Fax:706-869-7380
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health