Provider Demographics
NPI:1063570208
Name:CORNWELL, REBECCA HICOCK (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:HICOCK
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:CORNWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28251 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HALLWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:23359
Mailing Address - Country:US
Mailing Address - Phone:757-854-1667
Mailing Address - Fax:
Practice Address - Street 1:422 WEST MARKET STREET
Practice Address - Street 2:SUITE A
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-3547
Practice Address - Country:US
Practice Address - Phone:410-632-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG11268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker