Provider Demographics
NPI:1275850091
Name:CORBETT, LISA MICHELLE (LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MICHELLE
Last Name:CORBETT
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:151 GILLS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-3296
Mailing Address - Country:US
Mailing Address - Phone:803-394-0479
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC64731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical