Provider Demographics
NPI:1912376690
Name:COREY ANDOLFI, MA, LMFT, NBCCH, PLLC
Entity Type:Organization
Organization Name:COREY ANDOLFI, MA, LMFT, NBCCH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANDOLFI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, NBCCH
Authorized Official - Phone:910-343-0145
Mailing Address - Street 1:1328 NORTH LAKE PARK BLVD., SUITE 109
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-6514
Mailing Address - Country:US
Mailing Address - Phone:910-294-0970
Mailing Address - Fax:910-458-4824
Practice Address - Street 1:1328 NORTH LAKE PARK BLVD., SUITE 109
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-6514
Practice Address - Country:US
Practice Address - Phone:910-294-0970
Practice Address - Fax:910-458-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty