Provider Demographics
NPI:1275698094
Name:BLANFORD, CORINNE LOUISE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:LOUISE
Last Name:BLANFORD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:CORINNE
Other - Middle Name:LOUISE
Other - Last Name:RIDENOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:NAVAL HOSPITAL
Mailing Address - Street 2:100 BREWSTER BLVD
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2538
Mailing Address - Country:US
Mailing Address - Phone:910-450-4136
Mailing Address - Fax:910-450-4558
Practice Address - Street 1:NAVAL HOSPITAL
Practice Address - Street 2:100 BREWSTER BLVD
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2538
Practice Address - Country:US
Practice Address - Phone:910-450-4136
Practice Address - Fax:910-450-4558
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical