Individual
AMANDA VIRGINIA CORNELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1405 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-9301
(651) 895-3624
Mailing address
1405 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-9301
(651) 895-3624
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
00765
MN
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
05/17/2011
Last updated
05/17/2011
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