Basic Information
| Provider Information | |||||||||
| NPI: | 1922529312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORLEY | ||||||||
| FirstName: | VALERIE | ||||||||
| MiddleName: | ELLISON | ||||||||
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| Credential: | MA, NCC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 291 WILLIAM AVE | ||||||||
| Address2: | |||||||||
| City: | JANE LEW | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263788124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044766009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3 HEALTHCARE DR | ||||||||
| Address2: | |||||||||
| City: | PHILIPPI | ||||||||
| State: | WV | ||||||||
| PostalCode: | 264169405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044572800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2017 | ||||||||
| LastUpdateDate: | 07/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1920 | WV | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.