Healthcare Provider Details

I. General information

NPI: 1073184594
Provider Name (Legal Business Name): DEMETRIA CORLEW LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 UPTOWN SQ
MURFREESBORO TN
37129-0573
US

IV. Provider business mailing address

2331 CHANDLER PL
MURFREESBORO TN
37130-5967
US

V. Phone/Fax

Practice location:
  • Phone: 931-532-0606
  • Fax:
Mailing address:
  • Phone: 615-947-4429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4713
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: