Provider Demographics
NPI:1033717335
Name:KORAHAIS, ANN W (LMHC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:W
Last Name:KORAHAIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 EAGLE WATCH DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8642
Mailing Address - Country:US
Mailing Address - Phone:904-505-9332
Mailing Address - Fax:
Practice Address - Street 1:1775 EAGLE WATCH DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8642
Practice Address - Country:US
Practice Address - Phone:904-505-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health