Provider Demographics
NPI:1629771761
Name:CORLEY, PORCHE LASHOADE (LCSW)
Entity Type:Individual
Prefix:
First Name:PORCHE
Middle Name:LASHOADE
Last Name:CORLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-7700
Mailing Address - Country:US
Mailing Address - Phone:912-421-9794
Mailing Address - Fax:
Practice Address - Street 1:1240 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-7700
Practice Address - Country:US
Practice Address - Phone:912-421-9794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0085341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical