Provider Demographics
NPI:1710120738
Name:SECREST, CORINNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:
Last Name:SECREST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854A HENDERSONVILLE RD # 110
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2467
Mailing Address - Country:US
Mailing Address - Phone:704-608-2142
Mailing Address - Fax:
Practice Address - Street 1:4 SOURWOOD DR
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759
Practice Address - Country:US
Practice Address - Phone:704-608-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102804103TC0700X
NC3930103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical