Provider Demographics
NPI:1720974637
Name:CORKREN, KAITLIN ANN (EDS, LPCA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANN
Last Name:CORKREN
Suffix:
Gender:F
Credentials:EDS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 GEORGIA QUEEN DR
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-8602
Mailing Address - Country:US
Mailing Address - Phone:678-200-8773
Mailing Address - Fax:
Practice Address - Street 1:202 GEORGIA QUEEN DR
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-8602
Practice Address - Country:US
Practice Address - Phone:678-200-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health