Jonathan Cordell, PSYD
Individual provider Active NPI Psychologist · Willow Spring, NC
NPI 1689394116 · NPPES record last updated Nov 10, 2024
Key facts
- NPI
- 1689394116
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 2249 (AL)
- Practice address
- 2005 Big Panther Dr
Willow Spring, NC 27592-6020 - Phone
- (919) 816-5820
- NPI assigned
- Sep 2, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35SI00700000 | NJ | MD | Psychologist |
| 6654 | NC | MD | Endodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6654 | NC | |
| Psychologist | 103T00000X | 35SI00700000 | NJ | |
| Psychologist | 103T00000X | 2249 | AL | Yes |
Addresses
Primary practice location
2005 Big Panther Dr
Willow Spring, NC 27592-6020
Mailing address
2005 Big Panther Dr
Willow Spring, NC 27592-6020
Phone (919) 816-5820
Other providers in Willow Spring, NC
- Avery Chase
- Alison Bethany Chavarriaga
- Clark Family Care Home
- April Clark
- Commissioned Health PLLC
- Nicole Diana Coughlin
- Christian Davis
- Dogwood Rehab, PLLC
- Dr Alan L Byrd and Associates of Angier OD PA
- Jennifer Easley
All providers in Willow Spring, NC · Psychologist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.