Provider Demographics
NPI:1255825519
Name:KORNEGAY, SOPHIA (LPC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:KORNEGAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 E 29TH ST UNIT 347
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3901
Mailing Address - Country:US
Mailing Address - Phone:832-568-7522
Mailing Address - Fax:
Practice Address - Street 1:527 SOUTHWEST PKWY APT 101
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-7142
Practice Address - Country:US
Practice Address - Phone:832-568-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76413101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty