Provider Demographics
NPI:1386123651
Name:WILLIAMS, CORINNE ELICIA BLOOM
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:ELICIA BLOOM
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:ELICIA
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA, LBA
Mailing Address - Street 1:664 POWERS AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36205-4419
Mailing Address - Country:US
Mailing Address - Phone:256-847-5942
Mailing Address - Fax:
Practice Address - Street 1:664 POWERS AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36205-4419
Practice Address - Country:US
Practice Address - Phone:256-847-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 106E00000X
AL2025-058103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSMedicaid