Individual
COREY JORDAN FREDERICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 E MARKET ST, GREENSBORO, NC 27411-0002
(718) 798-1418
Mailing address
635 ARNOW AVE APT 2C, BRONX, NY 10467-7019
(646) 260-2334
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
3344567
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
567DP244
—
NC
Enumeration date
07/26/2021
Last updated
07/26/2021
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