MEDICARE: ERICA CORBIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	A13939	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	A13939	NC
3	101YM0800X	Mental Health Counselor	A13939	NC

General Provider Information

NPI Number	:	1437649977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA CORBIN

Provider Business Mailing Address
First Line	:	100 AUBURN CV
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-8107
Country	:	US
Telephone Number	:	704-601-6652
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 EXECUTIVE CENTER DR STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-8897
Country	:	US
Telephone Number	:	704-567-0790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	10/17/2023

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Directions to “ ERICA CORBIN ” Practice Location

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