GRADY RICHARD CORBIN LPC
NPI 1770226573
Counselor - Professional in Gulfport, MS
Active since April 19, 2022
About Grady Richard Corbin Lpc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GRADY RICHARD CORBIN LPC (NPI 1770226573) is an individual professional provider in Gulfport, Mississippi, licensed in Mississippi (222) and active in the NPI registry since April 2022. He maintains a secondary practice location in Gulfport.
NPPES Registry Identity
NPI1770226573
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameGRADY RICHARD CORBINCredential: LPC
Location Address2224 25TH AVEGulfport, MS 39501-4520
Mailing Address2501 Gulf Ave Apt 29Gulfport, MS 39501-3436
Phone(479) 244-0495
Sole ProprietorYes
Enumeration DateApril 19, 2022
NPPES CertifiedApril 19, 2022
✔ NPI 1770226573 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in MS · 222
2224 25TH AVE, Gulfport, MS 39501
Secondary Practice Location 1
Location 12501 Gulf Ave Apt 29Gulfport, MS 39501-3436 · Phone (479) 244-0495
Group Practice 1
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1770226573, enumerated as an "individual" on April 19, 2022.
The provider is located at 2224 25TH AVE GULFPORT, MS 39501 and the phone number is (479) 244-0495.
Counselor with taxonomy code 101YP2500X and a focus in Professional.
