Provider Demographics
NPI:1780485367
Name:CORBETT, EBONIK (LMSW)
Entity type:Individual
Prefix:MS
First Name:EBONIK
Middle Name:
Last Name:CORBETT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BARTLETT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4276
Mailing Address - Country:US
Mailing Address - Phone:803-470-4522
Mailing Address - Fax:
Practice Address - Street 1:885 GOLD HILL RD # 320
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7946
Practice Address - Country:US
Practice Address - Phone:803-470-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17508104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker