Provider Demographics
NPI:1245441435
Name:LASALLE, CORALIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CORALIE
Middle Name:
Last Name:LASALLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 1/2 SUNNYNOOK DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1723
Mailing Address - Country:US
Mailing Address - Phone:323-663-3071
Mailing Address - Fax:323-668-2206
Practice Address - Street 1:320 ARDEN AVE, STE 240
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1128
Practice Address - Country:US
Practice Address - Phone:323-663-3071
Practice Address - Fax:323-668-2206
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 87191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical