Provider Demographics
NPI:1821012766
Name:CORDELL, MARTHA BROWNING (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:BROWNING
Last Name:CORDELL
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 1:1111 WELLSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8580
Mailing Address - Country:US
Mailing Address - Phone:919-649-7933
Mailing Address - Fax:
Practice Address - Street 1:1140 HOLLY SPRINGS RD
Practice Address - Street 2:SUITE 207
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9634
Practice Address - Country:US
Practice Address - Phone:919-649-7933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0012931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19243OtherBLUE CROSS BLUE SHIELD
NC6003524Medicaid
NC19243OtherBLUE CROSS BLUE SHIELD