Provider Demographics
NPI:1073580080
Name:CORRELL, JAMES ALLEN (EDD, LCP)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:CORRELL
Suffix:
Gender:M
Credentials:EDD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320A CHARLES DIMMOCK PARKWAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:804-520-5485
Mailing Address - Fax:804-520-6329
Practice Address - Street 1:320A CHARLES DIMMOCK PARKWAY
Practice Address - Street 2:SUITE 4
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-520-5485
Practice Address - Fax:804-520-6329
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001723103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007712251Medicaid
VA007712251Medicaid
VAR36240Medicare UPIN