Provider Demographics
NPI:1982459251
Name:CORBETT, DEMONIQUE (LCAS, CFE)
Entity Type:Individual
Prefix:
First Name:DEMONIQUE
Middle Name:
Last Name:CORBETT
Suffix:
Gender:F
Credentials:LCAS, CFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N 3RD ST STE 401
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3474
Mailing Address - Country:US
Mailing Address - Phone:910-769-9126
Mailing Address - Fax:910-769-9169
Practice Address - Street 1:720 N 3RD ST STE 401
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3474
Practice Address - Country:US
Practice Address - Phone:910-769-9126
Practice Address - Fax:910-769-9169
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20362101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)