Provider Demographics
NPI:1649745340
Name:CORONA, MIRIAM E (LPC, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:E
Last Name:CORONA
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 90TH ST
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-1806
Mailing Address - Country:US
Mailing Address - Phone:414-554-8540
Mailing Address - Fax:
Practice Address - Street 1:6121 GREEN BAY RD STE 200
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2931
Practice Address - Country:US
Practice Address - Phone:262-864-1141
Practice Address - Fax:262-351-0132
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16627-132101YA0400X
WI8781-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)