Provider Demographics
NPI:1992267769
Name:EDWARDS, CORRINE (MS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 WILLOW LANE
Mailing Address - Street 2:N/A
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2707
Mailing Address - Country:US
Mailing Address - Phone:570-878-4633
Mailing Address - Fax:
Practice Address - Street 1:507 WILLOW LANE
Practice Address - Street 2:N/A
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-2707
Practice Address - Country:US
Practice Address - Phone:570-878-4633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional