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General NPI Number Information
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NPI Number | 1104586304
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Entity Type | Individual
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Provider Name | ANGELA MICHELLE CORNETT M. ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 12/29/2021
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 109 MAIN ST
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City | PENNINGTON GAP
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State | VA
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Zip | 24277-3211
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Country | US
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Telephone | 276-546-3330
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Fax | 276-386-3338
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Provider Business Mailing Address
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Address Line | 109 MAIN ST
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City | PENNINGTON GAP
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State | VA
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Zip | 24277-3211
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Country | US
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Telephone | 276-546-3330
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Fax | 276-386-3338
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701011110
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701011110
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License Number State | VA
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