Provider Demographics
NPI:1184209132
Name:CORK, GRETA ANGSTADT (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:ANGSTADT
Last Name:CORK
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 SWEETBAY PKWY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:GA
Mailing Address - Zip Code:31811-7620
Mailing Address - Country:US
Mailing Address - Phone:706-668-0529
Mailing Address - Fax:
Practice Address - Street 1:401 RIDLEY AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2267
Practice Address - Country:US
Practice Address - Phone:706-756-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional