Provider Demographics
NPI:1982207924
Name:KORONKA, KALEE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KALEE
Middle Name:
Last Name:KORONKA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KALEE
Other - Middle Name:
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:P.O. BOX 310
Mailing Address - Street 2:1199 W. HARRIS AVE.
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764
Mailing Address - Country:US
Mailing Address - Phone:989-362-8636
Mailing Address - Fax:989-362-7800
Practice Address - Street 1:1199 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9681
Practice Address - Country:US
Practice Address - Phone:989-362-8636
Practice Address - Fax:989-362-7800
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223667101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional