Provider Demographics
NPI:1659438893
Name:KORNETT, LINDA CAROL (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:KORNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 WOODLAWN COURT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6358
Mailing Address - Country:US
Mailing Address - Phone:703-518-5184
Mailing Address - Fax:703-518-5185
Practice Address - Street 1:721 GIBBON STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314
Practice Address - Country:US
Practice Address - Phone:703-518-5184
Practice Address - Fax:703-518-5185
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health