Healthcare Provider Details

I. General information

NPI: 1336357466
Provider Name (Legal Business Name): CAROL HILDEGARD CORCORAN LCMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 RITCHIE HWY SUITE 100 #245
ARNOLD MD
21012-2703
US

IV. Provider business mailing address

1521 RITCHIE HWY SUITE 100 #245
ARNOLD MD
21012-2325
US

V. Phone/Fax

Practice location:
  • Phone: 443-254-0686
  • Fax: 410-349-3677
Mailing address:
  • Phone: 443-254-0686
  • Fax: 410-349-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM146
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-15453
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0001806
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC38043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: