Provider Demographics
NPI:1548851447
Name:CORBETT, AMANDA LORAINE (LCMHCA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LORAINE
Last Name:CORBETT
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LAKESIDE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6256
Mailing Address - Country:US
Mailing Address - Phone:336-403-0024
Mailing Address - Fax:
Practice Address - Street 1:500 LAKESIDE VALLEY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-6256
Practice Address - Country:US
Practice Address - Phone:336-403-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health