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General NPI Number Information
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NPI Number | 1114322625
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Entity Type | Organization
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Legal Business Name | ELIZABETH CORBETT, LLC
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 1612 MARION ST SUITE 311
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City | COLUMBIA
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State | SC
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Zip | 29201-2939
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Country | US
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Telephone | 803-361-7940
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Fax | 803-695-4935
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Provider Business Mailing Address
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Address Line | 105 LAZY ACRES DR
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City | COLUMBIA
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State | SC
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Zip | 29209-4255
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Country | US
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Telephone | 803-361-7940
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Fax | 803-695-4934
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Authorized Official
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Title or Position | OWNER
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Name | MISS ELIZABETH ANN CORBETT
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Credential | LCSW
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Telephone | 803-361-7940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4991
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License Number State | SC
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