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General NPI Number Information
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NPI Number | 1881415263
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Entity Type | Individual
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Provider Name | MR. FURMAN LADSON CORLEY III
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Gender | Male
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 151 BROZZINI CT
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City | GREENVILLE
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State | SC
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Zip | 29615-5340
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Country | US
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Telephone | 864-288-7636
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Fax |
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Provider Business Mailing Address
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Address Line | 210 LODGE DR
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City | GREENWOOD
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State | SC
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Zip | 29646-1912
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Country | US
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Telephone | 864-910-5808
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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 |
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License Number State |
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