Provider Demographics
NPI:1093315525
Name:PRY, CORRIE
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:PRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORRIE
Other - Middle Name:JO
Other - Last Name:ZALAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22420 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2879
Mailing Address - Country:US
Mailing Address - Phone:412-818-7252
Mailing Address - Fax:
Practice Address - Street 1:28303 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3040
Practice Address - Country:US
Practice Address - Phone:248-658-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)