Provider Demographics
NPI:1164164950
Name:GEOFFRION, CORINNE (LPC)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:GEOFFRION
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BRACKETT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3238
Mailing Address - Country:US
Mailing Address - Phone:720-593-4688
Mailing Address - Fax:
Practice Address - Street 1:285 BRACKETT ST APT 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3238
Practice Address - Country:US
Practice Address - Phone:720-593-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC6177101YP2500X
COLPC.0016732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional