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General NPI Number Information
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NPI Number | 1033409289
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Entity Type | Organization
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Legal Business Name | CORSICA FAMILY THERAPY, LLC
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 205 E WATER ST SUITE C
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City | CENTREVILLE
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State | MD
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Zip | 21617-1155
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Country | US
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Telephone | 410-490-9742
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 511
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City | CENTREVILLE
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State | MD
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Zip | 21617-0511
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Country | US
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Telephone | 410-490-9742
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ CLINICAL DIRECTOR
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Name | MRS. REBECCA ANN COOK
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Credential | LCSW-C
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Telephone | 410-490-9742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13638
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License Number State | MD
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