Healthcare Provider Details

I. General information

NPI: 1740864743
Provider Name (Legal Business Name): BIANCA JENAY CORNELIUS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 757-201-5685
  • Fax: 269-393-4609
Mailing address:
  • Phone: 757-201-5685
  • Fax: 269-393-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010479
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: