Provider Demographics
NPI:1679827588
Name:CHARM, CORINE MICHELE (MFT)
Entity Type:Individual
Prefix:MS
First Name:CORINE
Middle Name:MICHELE
Last Name:CHARM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 E CANYON RIM RD
Mailing Address - Street 2:101
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4317
Mailing Address - Country:US
Mailing Address - Phone:714-642-3237
Mailing Address - Fax:
Practice Address - Street 1:6200 E CANYON RIM RD
Practice Address - Street 2:205C
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4317
Practice Address - Country:US
Practice Address - Phone:714-642-3237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52333106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist