Healthcare Provider Details

I. General information

NPI: 1225606221
Provider Name (Legal Business Name): AYZHA GABRIELLE CORBETT LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W CHESAPEAKE AVE STE 518
TOWSON MD
21204-4892
US

IV. Provider business mailing address

40 W CHESAPEAKE AVE STE 518
TOWSON MD
21204-4892
US

V. Phone/Fax

Practice location:
  • Phone: 667-320-2173
  • Fax:
Mailing address:
  • Phone: 667-320-2173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC11713
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: