Healthcare Provider Details

I. General information

NPI: 1902726516
Provider Name (Legal Business Name): CORDELIA AGBELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 OAK BRANCH DR STE E
GREENSBORO NC
27407-2392
US

IV. Provider business mailing address

7 OAK BRANCH DR STE E
GREENSBORO NC
27407-2392
US

V. Phone/Fax

Practice location:
  • Phone: 704-210-8196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1576250
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: