Provider Demographics
NPI:1811168057
Name:COLSON, CASSANDRA KORNEGAY (LPC, ATR-BC, CSW)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:KORNEGAY
Last Name:COLSON
Suffix:
Gender:F
Credentials:LPC, ATR-BC, CSW
Other - Prefix:MISS
Other - First Name:CASSANDRA
Other - Middle Name:FAYE
Other - Last Name:KORNEGAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:691 SCARLETT CT
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27261-0431
Mailing Address - Country:US
Mailing Address - Phone:336-883-9389
Mailing Address - Fax:
Practice Address - Street 1:4530 SE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-9784
Practice Address - Country:US
Practice Address - Phone:336-674-4300
Practice Address - Fax:336-674-4290
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4236101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor