Provider Demographics
NPI:1740864743
Name:CORNELIUS, BIANCA JENAY (LPC)
Entity type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:JENAY
Last Name:CORNELIUS
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 1:2 EATON ST STE 1103
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4054
Mailing Address - Country:US
Mailing Address - Phone:757-838-1894
Mailing Address - Fax:757-838-1895
Practice Address - Street 1:2 EATON ST STE 1103
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4054
Practice Address - Country:US
Practice Address - Phone:757-838-1894
Practice Address - Fax:757-838-1895
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health