Provider Demographics
NPI:1720300122
Name:CORNISH, MELINDA J (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:J
Last Name:CORNISH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 OSTERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7525
Mailing Address - Country:US
Mailing Address - Phone:919-609-5679
Mailing Address - Fax:919-336-5185
Practice Address - Street 1:106 OSTERVILLE DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7525
Practice Address - Country:US
Practice Address - Phone:919-609-5679
Practice Address - Fax:919-336-5185
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0064801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical