Provider Demographics
NPI:1295054633
Name:CORBAN, ROBERT MILLSAPS (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MILLSAPS
Last Name:CORBAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4577 S EASON BLVD
Mailing Address - Street 2:SUITE E-F
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6590
Mailing Address - Country:US
Mailing Address - Phone:662-377-7590
Mailing Address - Fax:662-377-7595
Practice Address - Street 1:4577 S EASON BLVD
Practice Address - Street 2:SUITE E-F
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6590
Practice Address - Country:US
Practice Address - Phone:662-377-7590
Practice Address - Fax:662-377-7595
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC02731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical