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General NPI Number Information
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NPI Number | 1861729444
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Entity Type | Individual
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Provider Name | EDWARD JOSEPH KORN III L.C.S.W, L.A.D.A.C.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 01/08/2011
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Provider Practice Location Address
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Address Line | 200 S COLLEGE ST 315
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City | TRENTON
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State | TN
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Zip | 38382-1900
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Country | US
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Telephone | 731-855-4950
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 315
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City | TRENTON
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State | TN
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Zip | 38382-0315
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Country | US
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Telephone | 731-855-4950
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1064
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5165
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License Number State | TN
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