Provider Demographics
NPI:1134510191
Name:MILSAP, COREY (PSYD, LPC)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:MILSAP
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:DR
Other - First Name:COREY
Other - Middle Name:
Other - Last Name:LAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 GEORGIA AVE E UNIT 142181
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-5546
Mailing Address - Country:US
Mailing Address - Phone:678-833-5395
Mailing Address - Fax:844-799-6134
Practice Address - Street 1:175 CARNEGIE PL STE 117
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7903
Practice Address - Country:US
Practice Address - Phone:678-833-5395
Practice Address - Fax:844-799-6134
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008253101YP2500X, 101YM0800X
FLSS1424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003163439DMedicaid
GA003163439BMedicaid