Provider Demographics
NPI:1598321069
Name:MUNGIN, COREY ALLEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:ALLEN
Last Name:MUNGIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 CAMBRIAN DR
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-4516
Mailing Address - Country:US
Mailing Address - Phone:678-313-2815
Mailing Address - Fax:
Practice Address - Street 1:328 CAMBRIAN DR
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-4516
Practice Address - Country:US
Practice Address - Phone:678-313-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0064561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical