Provider Demographics
NPI:1801003371
Name:CORBETT, PAMELA D (MA, LPA)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:D
Last Name:CORBETT
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5736
Mailing Address - Country:US
Mailing Address - Phone:336-794-0011
Mailing Address - Fax:336-761-5949
Practice Address - Street 1:3560 BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5736
Practice Address - Country:US
Practice Address - Phone:336-761-1121
Practice Address - Fax:336-761-5949
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC923103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist