Provider Demographics
NPI:1447068333
Name:CORNELIUS, AMBER BRIENNE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:BRIENNE
Last Name:CORNELIUS
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 1:111 COUNTY ROAD 175
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:AL
Mailing Address - Zip Code:35963-3429
Mailing Address - Country:US
Mailing Address - Phone:256-601-8188
Mailing Address - Fax:
Practice Address - Street 1:125 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1625
Practice Address - Country:US
Practice Address - Phone:256-302-8699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst