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General NPI Number Information
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NPI Number | 1063033769
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Entity Type | Individual
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Provider Name | SHERLEITA JI-HAN CORLEY LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/04/2020
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Last Update Date | 05/04/2020
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Provider Practice Location Address
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Address Line | 6439 GARNERS FERRY RD
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City | COLUMBIA
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State | SC
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Zip | 29209-1638
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Country | US
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Telephone | 803-776-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 7259 SMITHFIELD RD
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City | COLUMBIA
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State | SC
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Zip | 29223-4812
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Country | US
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Telephone | 803-404-7274
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9409
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License Number State | SC
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