Provider Demographics
NPI:1992482194
Name:WALLIS, CORINNE BRIGGS (LCMHCA)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:BRIGGS
Last Name:WALLIS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55A LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-8788
Mailing Address - Country:US
Mailing Address - Phone:423-593-2127
Mailing Address - Fax:
Practice Address - Street 1:802 FAIRVIEW RD STE 4000
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1170
Practice Address - Country:US
Practice Address - Phone:828-367-7719
Practice Address - Fax:828-820-5503
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19051101YM0800X
COLPCC.0020928101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health