Provider Demographics
NPI:1306219316
Name:CORBETT, TARA LYNN (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:LYNN
Last Name:CORBETT
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444B BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4157
Mailing Address - Country:US
Mailing Address - Phone:803-883-4981
Mailing Address - Fax:803-883-5492
Practice Address - Street 1:444B BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4157
Practice Address - Country:US
Practice Address - Phone:803-883-4981
Practice Address - Fax:803-883-5492
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6425101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1694Medicaid