Provider Demographics
NPI:1700297603
Name:GILES, CORINA (LPC, NCC)
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:GILES
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-0872
Mailing Address - Country:US
Mailing Address - Phone:678-871-7529
Mailing Address - Fax:
Practice Address - Street 1:3133 GOLF RIDGE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1995
Practice Address - Country:US
Practice Address - Phone:678-871-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional