Healthcare Provider Details

I. General information

NPI: 1487054698
Provider Name (Legal Business Name): CORINNE RENEE ADAMS IMH11507
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LAKEVIEW DR SUITE 2
SEBRING FL
33870-3185
US

IV. Provider business mailing address

2100 LAKEVIEW DR SUITE 2
SEBRING FL
33870-3185
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-3388
  • Fax: 863-382-3389
Mailing address:
  • Phone: 863-382-3388
  • Fax: 863-382-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH11507
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: