Provider Demographics
NPI:1154612406
Name:KORNIYENKO, AGNESSA PETROVNA (MSMFT)
Entity type:Individual
Prefix:
First Name:AGNESSA
Middle Name:PETROVNA
Last Name:KORNIYENKO
Suffix:
Gender:F
Credentials:MSMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 DAZZLING CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1824
Mailing Address - Country:US
Mailing Address - Phone:719-684-6109
Mailing Address - Fax:
Practice Address - Street 1:6260 DAZZLING CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-1824
Practice Address - Country:US
Practice Address - Phone:719-684-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health