Provider Demographics
NPI:1881144707
Name:CORTRIGHT, CORNELIA MICHELLE
Entity type:Individual
Prefix:
First Name:CORNELIA
Middle Name:MICHELLE
Last Name:CORTRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:C.
Other - Middle Name:MICHELLE
Other - Last Name:CORTRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:2310 ELLIOTT AVE APT 317
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2128
Mailing Address - Country:US
Mailing Address - Phone:615-852-6506
Mailing Address - Fax:
Practice Address - Street 1:1609 HORTON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2827
Practice Address - Country:US
Practice Address - Phone:615-852-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional