Provider Demographics
NPI:1093049975
Name:CORBY, SALLY A (LCSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:CORBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E MAIN ST
Mailing Address - Street 2:STE. 406
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3636
Mailing Address - Country:US
Mailing Address - Phone:217-398-9066
Mailing Address - Fax:217-398-9077
Practice Address - Street 1:44 E MAIN ST
Practice Address - Street 2:STE. 406
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3636
Practice Address - Country:US
Practice Address - Phone:217-398-9066
Practice Address - Fax:217-398-9077
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0133001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical