Healthcare Provider Details

I. General information

NPI: 1518536994
Provider Name (Legal Business Name): CHRISTOPHER CORO LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 STONE ST
AUGUSTA ME
04330-5227
US

IV. Provider business mailing address

2 MAIN ST APT 422
BIDDEFORD ME
04005-2041
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-3455
  • Fax: 207-626-3455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC7554
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL6291
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: