Healthcare Provider Details

I. General information

NPI: 1972942191
Provider Name (Legal Business Name): CORC FAMILY COUNSELING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 N MAIN ST
LAKE ELSINORE CA
92530-4012
US

IV. Provider business mailing address

252 N MAIN ST
LAKE ELSINORE CA
92530-4012
US

V. Phone/Fax

Practice location:
  • Phone: 951-318-1351
  • Fax: 866-288-5478
Mailing address:
  • Phone: 951-318-1351
  • Fax: 866-288-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON FERREIRO
Title or Position: CEO
Credential: MA
Phone: 951-318-1351