Healthcare Provider Details

I. General information

NPI: 1679827588
Provider Name (Legal Business Name): CORINE MICHELE CHARM MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MAGNOLIA AVE
LONG BEACH CA
90806-4521
US

IV. Provider business mailing address

6200 E CANYON RIM RD 101
ANAHEIM CA
92807-4317
US

V. Phone/Fax

Practice location:
  • Phone: 562-218-1868
  • Fax:
Mailing address:
  • Phone: 714-642-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94024016
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number52333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: