Healthcare Provider Details

I. General information

NPI: 1225706468
Provider Name (Legal Business Name): CORNELL PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MAXWELL ST
CHESAPEAKE VA
23322-1622
US

IV. Provider business mailing address

505 MAXWELL ST
CHESAPEAKE VA
23322-1622
US

V. Phone/Fax

Practice location:
  • Phone: 757-618-6565
  • Fax: 757-410-8963
Mailing address:
  • Phone: 757-618-6565
  • Fax: 757-410-8963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY CORNELL
Title or Position: OWNER/MANAGER
Credential: PSYD
Phone: 757-618-6565