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Individual
TIA CORNWALL
Active
Individual
TIA CORNWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S., LPA
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6811
NC
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
6811
NC
103TS0200X
School Psychologist
1244890
NC
Other
Enumeration date
02/27/2018
Last updated
08/10/2026
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