Provider Demographics
NPI:1679302087
Name:CORDLE, MCKENA
Entity type:Individual
Prefix:
First Name:MCKENA
Middle Name:
Last Name:CORDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 JEFFERSONVILLE ST
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-5396
Mailing Address - Country:US
Mailing Address - Phone:276-988-5511
Mailing Address - Fax:
Practice Address - Street 1:506 JEFFERSONVILLE ST
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-5396
Practice Address - Country:US
Practice Address - Phone:276-988-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool