Provider Demographics
NPI:1780385914
Name:CORBITT, INIAH (MED, LAC)
Entity type:Individual
Prefix:
First Name:INIAH
Middle Name:
Last Name:CORBITT
Suffix:
Gender:F
Credentials:MED, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 DENBIGH CT
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2611
Mailing Address - Country:US
Mailing Address - Phone:609-453-5710
Mailing Address - Fax:
Practice Address - Street 1:2106 NEW RD STE E4
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1052
Practice Address - Country:US
Practice Address - Phone:609-350-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00680700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health