MEDICARE: COREY ANDOLFI MA, LMFT, NBCCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1609184431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY ANDOLFI MA, LMFT, NBCCH

Provider Business Mailing Address
First Line	:	1328 LAKE PARK BLVD N STE 109
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-3906
Country	:	US
Telephone Number	:	910-294-0970
Fax Number	:	910-458-4824

Provider Business Practice Location Address
First Line	:	1328 LAKE PARK BLVD N STE 109
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-3906
Country	:	US
Telephone Number	:	910-294-0970
Fax Number	:	910-458-4824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	12/15/2022

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