Provider Demographics
NPI:1336171099
Name:CORBETT, TRACY WOSKE (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:WOSKE
Last Name:CORBETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 N OAK STREET EXT BLDG D
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1066
Mailing Address - Country:US
Mailing Address - Phone:229-244-2030
Mailing Address - Fax:229-244-2038
Practice Address - Street 1:3312 N OAK STREET EXT BLDG D
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1066
Practice Address - Country:US
Practice Address - Phone:229-244-2030
Practice Address - Fax:229-244-2038
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0028251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFGQMedicare ID - Type Unspecified
GAP24365Medicare UPIN