Provider Demographics
NPI:1508504903
Name:CORREA, CORRINA MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CORRINA
Middle Name:MARIE
Last Name:CORREA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42174 SWEENEY LN
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-4461
Mailing Address - Country:US
Mailing Address - Phone:559-639-3246
Mailing Address - Fax:
Practice Address - Street 1:11408 LAKE SHERWOOD AVE N STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-0421
Practice Address - Country:US
Practice Address - Phone:225-261-7143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
LA17036104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator