Provider Demographics
NPI:1609255884
Name:CORBIN, JESSICA (LPC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAPC
Mailing Address - Street 1:3095 ABERDEEN CV
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1540
Mailing Address - Country:US
Mailing Address - Phone:678-386-6594
Mailing Address - Fax:
Practice Address - Street 1:2090 SUGARLOAF PKWY STE 115
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-9402
Practice Address - Country:US
Practice Address - Phone:770-676-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004869101YM0800X
GALPC010546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health