Provider Demographics
NPI:1841738564
Name:CORBIN, LISA (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 SENTRY PKWY W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2207
Mailing Address - Country:US
Mailing Address - Phone:215-767-7096
Mailing Address - Fax:
Practice Address - Street 1:1777 SENTRY PKWY W
Practice Address - Street 2:SUITE 300
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2207
Practice Address - Country:US
Practice Address - Phone:215-767-7096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health