Provider Demographics
NPI:1447856240
Name:DABNEY, COREY (LPHA)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:DABNEY
Suffix:
Gender:M
Credentials:LPHA
Other - Prefix:DR
Other - First Name:COREY
Other - Middle Name:
Other - Last Name:DABNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPHA
Mailing Address - Street 1:845 W 69TH ST LOWR SOUTH
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-1709
Mailing Address - Country:US
Mailing Address - Phone:773-651-6809
Mailing Address - Fax:
Practice Address - Street 1:845 W 69TH ST LOWR SOUTH
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1709
Practice Address - Country:US
Practice Address - Phone:773-651-6809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1337-124106H00000X
IL166.001423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist