Provider Demographics
NPI:1962126516
Name:CORRA, ASHLI NICOLE
Entity type:Individual
Prefix:
First Name:ASHLI
Middle Name:NICOLE
Last Name:CORRA
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 1:1100 9TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-2176
Mailing Address - Country:US
Mailing Address - Phone:304-580-9352
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH ST STE F
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-2176
Practice Address - Country:US
Practice Address - Phone:304-580-9352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor