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General NPI Number Information
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NPI Number | 1033499173
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Entity Type | Individual
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Provider Name | CHIQUITHA CORNELIUS
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Gender | Female
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Dates
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Enumeration Date | 08/21/2011
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 3130 S 11TH ST STE 105
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City | NILES
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State | MI
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Zip | 49120-4736
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Country | US
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Telephone | 574-274-0152
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 S 11TH ST STE 105
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City | NILES
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State | MI
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Zip | 49120-4736
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Country | US
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Telephone | 574-274-0152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 6301015882
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301015882
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 6301015882
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 103TP0814X
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Taxonomy Name | Psychoanalysis Psychologist
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License Number | 6301015882
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 6301015882
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801095307
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 6830101788
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License Number State | MI
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Taxonomy #8
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 6301015882
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License Number State | MI
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