Provider Demographics
NPI:1699027961
Name:CORBIN, ANGEL DAVIS (LPC, LCAS)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:DAVIS
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 21ST AVE N STE 17
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-7496
Mailing Address - Country:US
Mailing Address - Phone:843-868-6200
Mailing Address - Fax:843-868-6200
Practice Address - Street 1:1551 21ST AVE N STE 17
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-7496
Practice Address - Country:US
Practice Address - Phone:843-868-6200
Practice Address - Fax:843-868-6200
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3242101YA0400X
NC9733101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional