Provider Demographics
NPI:1356883649
Name:CORNETT, MADELINE (MS, LPC)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:CORNETT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4467 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-4967
Mailing Address - Country:US
Mailing Address - Phone:334-545-0164
Mailing Address - Fax:888-792-8287
Practice Address - Street 1:1518 ANDREWS AVE STE D
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-3716
Practice Address - Country:US
Practice Address - Phone:334-545-0164
Practice Address - Fax:888-972-8287
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2701A101YM0800X
ALLPC03918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health