Provider Demographics
NPI:1538291067
Name:COREY, WILLIAM FREDERIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERIC
Last Name:COREY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W ISLAND SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1645
Mailing Address - Country:US
Mailing Address - Phone:912-427-0870
Mailing Address - Fax:
Practice Address - Street 1:PSYCHOLOGY SERVICES DEPT
Practice Address - Street 2:2600 HWY 301 SOUTH
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31599-0001
Practice Address - Country:US
Practice Address - Phone:912-427-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical