Kimberly Cornelius

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

25742 Issued in NC

Practice address

1504 Jake Alexander Blvd W
Salisbury, NC 28147-1213

Phone

(704) 645-5839

NPI assigned

Feb 5, 2020

Last updated

Jun 28, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1851923197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 JAKE ALEXANDER BLVD W",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281471213",
            "telephone_number": "704-645-5839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 JAKE ALEXANDER BLVD W",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281471213",
            "telephone_number": "704-645-5839"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1504 Jake Alexander Blvd W",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "NC",
            "postal_code": "281471213",
            "country_code": "US",
            "telephone_number": "704-645-5839 x70464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORNELIUS",
        "first_name": "KIMBERLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-05",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "25742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Traylor Cooley, MSSW
• Debra T Cooper, MD
• Lauren Copper
• Copperfield Medical Center, PLLC
• Aubrie Norris Cornelius, N.P.
• Scott Shimizu Cornfield
• Jeff Corriher, COTA/L
• Micah Helms Corriher, PHARMD
• Dan N Cotoman, M.D.
• Philip Cottraux

• Addiction (Substance Use Disorder) Counselor in Salisbury, NC
• Providers in Salisbury, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.