Provider Demographics
NPI:1922855337
Name:CORNETT, KERIN (LCMHCA)
Entity type:Individual
Prefix:MRS
First Name:KERIN
Middle Name:
Last Name:CORNETT
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 LAKEVIEW ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569-9215
Mailing Address - Country:US
Mailing Address - Phone:919-912-1718
Mailing Address - Fax:
Practice Address - Street 1:6085 US HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NC
Practice Address - Zip Code:27569-8411
Practice Address - Country:US
Practice Address - Phone:919-912-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health