Healthcare Provider Details

I. General information

NPI: 1942118708
Provider Name (Legal Business Name): RACQUEL ALIZE LINTON KORNEGAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11019 POINTER RIDGE DR
CHARLOTTE NC
28214-1035
US

IV. Provider business mailing address

11019 POINTER RIDGE DR
CHARLOTTE NC
28214-1035
US

V. Phone/Fax

Practice location:
  • Phone: 336-617-1535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023721
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: