Provider Information for 1740864743
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Ms. BIANCA JENAY CORNELIUS LPC
Sex: Female
NPI: 1740864743
Last Updated: 2021-05-06
Certification Date: 2021-05-06
Certification Date: 2021-05-06
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1740864743 | ||||||||
| Enumeration Date | 2021-05-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2 EATON ST STE 1103 HAMPTON, VA 23669-4054 United States Phone: 757-838-1894 | Fax:757-838-1895 | ||||||||
| Primary Practice Address | 2 EATON ST STE 1103 HAMPTON, VA 23669-4054 United States Phone: 757-838-1894 | Fax:757-838-1895 | ||||||||
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