Healthcare Provider Details

I. General information

NPI: 1841162146
Provider Name (Legal Business Name): ANNELISE CORNWELL LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5826 FAYETTEVILLE RD STE 211
DURHAM NC
27713-8684
US

IV. Provider business mailing address

PO BOX 748465
ATLANTA GA
30374-8465
US

V. Phone/Fax

Practice location:
  • Phone: 855-675-4144
  • Fax: 617-807-0958
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21896
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: