Provider Demographics
NPI:1073184594
Name:CORLEW, DEMETRIA (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:
Last Name:CORLEW
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 CHANDLER PL
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-5967
Mailing Address - Country:US
Mailing Address - Phone:615-947-4429
Mailing Address - Fax:
Practice Address - Street 1:205 UPTOWN SQ
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0573
Practice Address - Country:US
Practice Address - Phone:931-532-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health