Provider Demographics
NPI:1871897454
Name:NORMAN, CORLETHA
Entity type:Individual
Prefix:
First Name:CORLETHA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORLETHA
Other - Middle Name:
Other - Last Name:NORMAN-BEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1705 HIGHWAY 138 SE UNIT 83365
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-0162
Mailing Address - Country:US
Mailing Address - Phone:404-402-0650
Mailing Address - Fax:404-341-9834
Practice Address - Street 1:2375 WALL ST SE STE 140
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6702
Practice Address - Country:US
Practice Address - Phone:404-402-0650
Practice Address - Fax:404-341-9834
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39341041C0700X
GACSW0052551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical