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General NPI Number Information
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NPI Number | 1942479381
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Entity Type | Individual
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Provider Name | CORETHA MARIE CLAIBORN CSAC,MAC,SAP,LSATP
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Gender | Female
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 700 S. SYCAMORE STREET SUITE 6
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City | PETERSBURG
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State | VA
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Zip | 23234
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Country | US
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Telephone | 804-855-8625
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Fax |
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Provider Business Mailing Address
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Address Line | 7053 OMALLEY DRIVE
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City | RICHMOND
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State | VA
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Zip | 23234
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Country | US
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Telephone | 804-275-2340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710101777
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0718000231
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License Number State | VA
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