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General NPI Number Information
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NPI Number | 1912376690
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Entity Type | Organization
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Legal Business Name | COREY ANDOLFI, MA, LMFT, NBCCH, PLLC
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 1328 NORTH LAKE PARK BLVD., SUITE 109
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City | CAROLINA BEACH
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State | NC
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Zip | 28428-6514
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Country | US
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Telephone | 910-294-0970
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Fax | 910-458-4824
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Provider Business Mailing Address
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Address Line | 1328 NORTH LAKE PARK BLVD., SUITE 109
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City | CAROLINA BEACH
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State | NC
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Zip | 28428-6514
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Country | US
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Telephone | 910-294-0970
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Fax | 910-458-4824
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Authorized Official
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Title or Position | OWNER
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Name | COREY F. ANDOLFI
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Credential | MA, LMFT, NBCCH
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Telephone | 910-343-0145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1562
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License Number State | NC
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