Provider Demographics
NPI:1699304824
Name:IMPACT CLINICAL CONSULTING, LLC
Entity type:Organization
Organization Name:IMPACT CLINICAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISW-CP
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-549-8221
Mailing Address - Street 1:PO BOX 1833
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:458 OLD CHEROKEE RD STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6971
Practice Address - Country:US
Practice Address - Phone:803-549-8221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty