Provider Demographics
NPI:1609531615
Name:CORRELL, CHARLENA JUDITH CATHERINE (LPC)
Entity type:Individual
Prefix:
First Name:CHARLENA
Middle Name:JUDITH CATHERINE
Last Name:CORRELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 RIVER WATCH DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8669
Mailing Address - Country:US
Mailing Address - Phone:757-270-3976
Mailing Address - Fax:
Practice Address - Street 1:1021 EDEN WAY N STE 109
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2776
Practice Address - Country:US
Practice Address - Phone:757-410-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17869101YM0800X
VA0701010974101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health