Provider Demographics
NPI:1154048106
Name:CORNELIUS, YOLANDA LOUISE (LCDC-I)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:LOUISE
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:LCDC-I
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:LOUISE
Other - Last Name:THOMAS-CORNELIUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCDC
Mailing Address - Street 1:2010 AL LIPSCOMB WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-2773
Mailing Address - Country:US
Mailing Address - Phone:972-971-2142
Mailing Address - Fax:
Practice Address - Street 1:2010 AL LIPSCOMB WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-2773
Practice Address - Country:US
Practice Address - Phone:972-971-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54569101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)