Provider Demographics
NPI:1841736204
Name:CORPORAN, HELEN
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:CORPORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15480 ANNAPOLIS RD SUITE RD SUITE 202 #407
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1803
Mailing Address - Country:US
Mailing Address - Phone:301-392-7075
Mailing Address - Fax:301-576-5487
Practice Address - Street 1:15480 ANNAPOLIS RD STE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1852
Practice Address - Country:US
Practice Address - Phone:301-392-7075
Practice Address - Fax:301-576-5487
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC-616-302-012-608106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician