Individual
MYRA R CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1000 BRIDLE PATH DR, LAWRENCEVILLE, GA 30045-8208
(404) 538-6128
Mailing address
1000 BRIDLE PATH DR, LAWRENCEVILLE, GA 30045-8208
(404) 538-6128
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
005243
GA
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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