Provider Demographics
NPI:1861729444
Name:KORN, EDWARD JOSEPH III (LCSW, LADAC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:KORN
Suffix:III
Gender:M
Credentials:LCSW, LADAC
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:KORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-0315
Mailing Address - Country:US
Mailing Address - Phone:731-855-4950
Mailing Address - Fax:
Practice Address - Street 1:200 S COLLEGE ST
Practice Address - Street 2:315
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-1900
Practice Address - Country:US
Practice Address - Phone:731-855-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1064101YA0400X
TN51651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)