Provider Demographics
NPI:1659414977
Name:CORBIN, PATRICIA JANE (LSW, ACSW, LCAC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JANE
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LSW, ACSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 13TH ST STE 2540
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1305
Mailing Address - Country:US
Mailing Address - Phone:812-372-3745
Mailing Address - Fax:812-372-5367
Practice Address - Street 1:1531 13TH ST STE 2540
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-1305
Practice Address - Country:US
Practice Address - Phone:812-372-3745
Practice Address - Fax:812-372-5367
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33004898A104100000X
IN87000036A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN039097OtherSIHO NETWORK
IN000000335104OtherANTHEM NETWORK
IN300046902Medicaid