Provider Demographics
NPI:1528108099
Name:WENZE, CORNELIA (EDD)
Entity type:Individual
Prefix:DR
First Name:CORNELIA
Middle Name:
Last Name:WENZE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MAIN ST UNIT 120
Mailing Address - Street 2:
Mailing Address - City:PORTERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30070-3305
Mailing Address - Country:US
Mailing Address - Phone:404-618-4843
Mailing Address - Fax:470-441-9183
Practice Address - Street 1:500 LANIER AVE W STE 103B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7640
Practice Address - Country:US
Practice Address - Phone:404-800-4002
Practice Address - Fax:404-393-5698
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010382101YP2500X
FLMH7527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health