Provider Demographics
NPI:1609993799
Name:MASSEY, CORLISS WILLIAMS (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CORLISS
Middle Name:WILLIAMS
Last Name:MASSEY
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 1:2600 E SOUTH BLVD
Mailing Address - Street 2:SUITE 247
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2515
Mailing Address - Country:US
Mailing Address - Phone:334-356-6238
Mailing Address - Fax:
Practice Address - Street 1:2600 E SOUTH BLVD
Practice Address - Street 2:SUITE 247
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2515
Practice Address - Country:US
Practice Address - Phone:334-356-6238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2178101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional