Provider Demographics
NPI:1447986351
Name:ENNIS, CORINNE MARIE
Entity type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:MARIE
Last Name:ENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CORINNE
Other - Middle Name:MARIE
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:451 WELSH HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71 FLINT DR
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3746
Practice Address - Country:US
Practice Address - Phone:410-996-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health