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NPI Code Detail

MEDICARE: YOLANDA LOUISE CORNELIUS LCDC-I

MEDICARE: YOLANDA LOUISE CORNELIUS LCDC-I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor54569TX

General Provider Information

NPI Number : 1154048106
Entity Type Code : Individual
Provider Name (Legal Business Name) : YOLANDA LOUISE CORNELIUS LCDC-I
Provider Business Mailing Address
First Line : 2010 AL LIPSCOMB WAY
Second Line :
City : DALLAS
State : TX
Zip : 75215-2773
Country : US
Telephone Number : 972-971-2142
Fax Number :
Provider Business Practice Location Address
First Line : 2010 AL LIPSCOMB WAY
Second Line :
City : DALLAS
State : TX
Zip : 75215-2773
Country : US
Telephone Number : 972-971-2142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2022
Last Update Date : 10/20/2022

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Directions to “ YOLANDA LOUISE CORNELIUS LCDC-I” Practice Location

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