Individual
DR. STEPHANI LEE CORNELISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LCSW
Contact information
Practice address
206 THOMAS DR, LAGRANGE, GA 30240-9126
(706) 616-3976
Mailing address
206 THOMAS DR, LAGRANGE, GA 30240-9126
(706) 616-3976
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW003562
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
376639331A
GEORGIA HEALTHY FAMILIES
GA
05
—
513478088A
—
GA
Enumeration date
11/01/2006
Last updated
09/29/2021
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