Provider Demographics
NPI:1992462071
Name:JEFFRIES, CORBIN CHRISTINE (LCSW)
Entity type:Individual
Prefix:
First Name:CORBIN
Middle Name:CHRISTINE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 DORSEY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2612
Mailing Address - Country:US
Mailing Address - Phone:502-245-1576
Mailing Address - Fax:
Practice Address - Street 1:1325 FALLEN TIMBER RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:KY
Practice Address - Zip Code:40050-6716
Practice Address - Country:US
Practice Address - Phone:502-259-8817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2561571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical