Provider Demographics
NPI:1033438114
Name:CORVASCE, ANTONIETTA (ANTONIETTA CORVASCE)
Entity Type:Individual
Prefix:
First Name:ANTONIETTA
Middle Name:
Last Name:CORVASCE
Suffix:
Gender:F
Credentials:ANTONIETTA CORVASCE
Other - Prefix:
Other - First Name:ANTONIETTA
Other - Middle Name:
Other - Last Name:CORVASCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2940 CHAIN BRIDGE RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3408
Mailing Address - Country:US
Mailing Address - Phone:202-363-6625
Mailing Address - Fax:
Practice Address - Street 1:1025 VERMONT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3516
Practice Address - Country:US
Practice Address - Phone:202-363-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional