Hargrove, Corie

Hargrove, Corie is an individual health care provider with primary practice located at 2405 Northwestern Ave # Ll15 , Racine WI 53404-2534. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Hargrove, Corie can be contacted via phone (262) 260-8370.

Contact Information

Primary practice address
2405 Northwestern Ave # Ll15 Racine WI 53404-2534
Phone: (262) 260-8370
Fax: (262) 260-8538
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 13772 Wisconsin

Profile Details

NPI number 1720124019
LBN Legal business name Hargrove, Corie
Credentials CADC-III
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2007
Last updated Dec 6th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720124019 NPPES
Wisconsin MEDICAID 39173200

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