Provider Demographics
NPI:1740019090
Name:FREDETTE, CORINNE LEE (CADC-1)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:LEE
Last Name:FREDETTE
Suffix:
Gender:F
Credentials:CADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 RIVERDALE CT APT 110
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-7773
Mailing Address - Country:US
Mailing Address - Phone:805-914-3511
Mailing Address - Fax:
Practice Address - Street 1:291 RIVERDALE CT APT 110
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-7773
Practice Address - Country:US
Practice Address - Phone:805-914-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI20530918101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)