Provider Demographics
NPI:1023568862
Name:CORPORATE CONSULTING & COACHING, INC.
Entity Type:Organization
Organization Name:CORPORATE CONSULTING & COACHING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:B
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:561-360-5050
Mailing Address - Street 1:21 THURLOW DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-7633
Mailing Address - Country:US
Mailing Address - Phone:561-360-5050
Mailing Address - Fax:
Practice Address - Street 1:21 THURLOW DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7633
Practice Address - Country:US
Practice Address - Phone:561-360-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH2035OtherLMHC MH2035