Healthcare Provider Details

I. General information

NPI: 1619590676
Provider Name (Legal Business Name): BETHANY H CORBIN LICDC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31891 SR-93
MCARTHUR OH
45651
US

IV. Provider business mailing address

31891 SR-93
MCARTHUR OH
45651
US

V. Phone/Fax

Practice location:
  • Phone: 740-596-5249
  • Fax:
Mailing address:
  • Phone: 740-596-5249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162605
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2208488
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: