Provider Demographics
NPI:1376677500
Name:CORRAL, ELENA EUGENIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:EUGENIA
Last Name:CORRAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WOODS LAKE RD STE 308
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2762
Mailing Address - Country:US
Mailing Address - Phone:864-735-5725
Mailing Address - Fax:864-751-5363
Practice Address - Street 1:25 WOODS LAKE RD STE 308
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2762
Practice Address - Country:US
Practice Address - Phone:864-735-5725
Practice Address - Fax:864-751-5363
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1127Medicaid