Provider Demographics
NPI:1265777296
Name:SMITH, CORINNE SERRA (LPC)
Entity type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:SERRA
Last Name:SMITH
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 1:219 S FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3233
Mailing Address - Country:US
Mailing Address - Phone:630-670-0232
Mailing Address - Fax:
Practice Address - Street 1:219 S FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3233
Practice Address - Country:US
Practice Address - Phone:630-670-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5638088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional