Provider Demographics
NPI:1699027961
Name:CORBIN, ANGEL DAVIS (LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:DAVIS
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 LIVINGSTON CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DELCO
Mailing Address - State:NC
Mailing Address - Zip Code:28436-9669
Mailing Address - Country:US
Mailing Address - Phone:910-617-0076
Mailing Address - Fax:910-874-8389
Practice Address - Street 1:711 LIVINGSTON CHAPEL RD
Practice Address - Street 2:
Practice Address - City:DELCO
Practice Address - State:NC
Practice Address - Zip Code:28436-9669
Practice Address - Country:US
Practice Address - Phone:910-617-0076
Practice Address - Fax:910-874-8389
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3242101YA0400X
NC9733101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health