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General NPI Number Information
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NPI Number | 1235044280
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Entity Type | Organization
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Legal Business Name | ROOTED IN PEARLS LLC
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Dates
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Enumeration Date | 08/15/2026
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Last Update Date | 08/15/2026
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Provider Practice Location Address
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Address Line | 256 N MACON ST STE 2
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City | JESUP
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State | GA
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Zip | 31545-5546
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Country | US
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Telephone | 912-424-1659
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Fax | 912-200-8511
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Provider Business Mailing Address
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Address Line | 256 N MACON ST STE 2
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City | JESUP
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State | GA
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Zip | 31545-5546
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Country | US
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Telephone | 912-424-1659
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Fax | 912-200-8511
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | PORCHE LASHOADE CORLEY
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Credential | LCSW
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Telephone | 912-424-1659
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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 |
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License Number State |
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