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General NPI Number Information
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NPI Number | 1780485367
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Entity Type | Individual
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Provider Name | EBONIK CORBETT LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 885 GOLD HILL RD # 320
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City | FORT MILL
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State | SC
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Zip | 29708-7946
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Country | US
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Telephone | 803-470-4522
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Fax |
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Provider Business Mailing Address
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Address Line | 114 BARTLETT DR
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City | COLUMBIA
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State | SC
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Zip | 29223-4276
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Country | US
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Telephone | 803-470-4522
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 17508
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License Number State | SC
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