Tia Cornwall, ED.S., LPA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6811 Issued in NC

Practice address

4902 Main St Ste D
Shallotte, NC 28470-4749

Phone

(910) 754-2289

NPI assigned

Feb 27, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Seaside Psychological Assessments and Resources for Kids PLLC

  • Psychologist
  • Shallotte, NC
  • NPI 1902773682
  NPD Authorized official
• Roanoke City Public Schools

  • Local Education Agency (LEA)
  • Roanoke, VA
  • NPI 1154348985
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786320000000",
    "number": "1710488408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1023",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284591023",
            "telephone_number": "540-314-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4902 MAIN ST STE D",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284704749",
            "telephone_number": "910-754-2289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNWALL",
        "first_name": "TIA",
        "credential": "ED.S., LPA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-27",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "6811",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NC",
            "license": "1244890",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Columbus Family Medical PA
• Brandee Condon, SLP
• Amanda Andrews Conway, PHARM D
• Elizabeth J Cooke, O.D.
• Joshua Copeland, PT, DPT
• Garrett Costin
• Kelsey Crist, LCMHCA, CCS, LCAS
• Jennifer Lynn Cully, MSN FNP-C
• Sara Culpepper, MS, LCAS-A
• Bethany I Cunningham, MS, CCC-SLP

• Psychologist in Shallotte, NC
• Providers in Shallotte, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.