Provider Demographics
NPI:1184063992
Name:WETZEL, COREY LYNNE (LPC)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:LYNNE
Last Name:WETZEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 S JACKSON SPRINGS RD APT 1
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1733
Mailing Address - Country:US
Mailing Address - Phone:636-236-1216
Mailing Address - Fax:
Practice Address - Street 1:1237 S JACKSON SPRINGS RD APT 1
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1733
Practice Address - Country:US
Practice Address - Phone:636-236-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009609101YM0800X
GALPC011111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health