Individual
COREY LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA, PRS-HS
Contact information
Practice address
2065 STONERIDGE DR, CIRCLEVILLE, OH 43113-8956
(740) 500-1391
Mailing address
2065 STONERIDGE DR, CIRCLEVILLE, OH 43113-8956
(740) 500-1391
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.192016
OH
171M00000X
Case Manager/Care Coordinator
—
OH
175T00000X
Peer Specialist
APS.004709
OH
Other
Enumeration date
12/20/2023
Last updated
04/23/2025
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