Provider Demographics
NPI:1053610238
Name:CORNELIUS, KARIMAH S (MA, LCPC)
Entity type:Individual
Prefix:MS
First Name:KARIMAH
Middle Name:S
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13151 LARCHDALE RD
Mailing Address - Street 2:#8
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1719
Mailing Address - Country:US
Mailing Address - Phone:340-332-4361
Mailing Address - Fax:
Practice Address - Street 1:13151 LARCHDALE RD
Practice Address - Street 2:#8
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1719
Practice Address - Country:US
Practice Address - Phone:340-332-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health