=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689553737
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CORINNE ELIZABETH LAVIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2025
-----------------------------------------------------
Last Update Date | 09/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1913 HIGHWAY 87
-----------------------------------------------------
City | NAVARRE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32566-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-816-8122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7639 PIPER CIR
-----------------------------------------------------
City | MILTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32583-8676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-705-1765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | IMH26065
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------