Healthcare Provider Details

I. General information

NPI: 1235044280
Provider Name (Legal Business Name): ROOTED IN PEARLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 N MACON ST STE 2
JESUP GA
31545-5546
US

IV. Provider business mailing address

256 N MACON ST STE 2
JESUP GA
31545-5546
US

V. Phone/Fax

Practice location:
  • Phone: 912-424-1659
  • Fax: 912-200-8511
Mailing address:
  • Phone: 912-424-1659
  • Fax: 912-200-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PORCHE LASHOADE CORLEY
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 912-424-1659