Provider Demographics
NPI:1184040453
Name:CORK, ANGELA LANETTE (PLMSW)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:LANETTE
Last Name:CORK
Suffix:
Gender:F
Credentials:PLMSW
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:LANETTE
Other - Last Name:CORK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLMSW
Mailing Address - Street 1:365 W REED RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-6967
Mailing Address - Country:US
Mailing Address - Phone:662-702-5108
Mailing Address - Fax:
Practice Address - Street 1:365 W REED RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-6967
Practice Address - Country:US
Practice Address - Phone:662-702-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker