Provider Demographics
NPI:1538941893
Name:CORNE, TRACI (MSCMHC NCC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:CORNE
Suffix:
Gender:F
Credentials:MSCMHC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 HARRIS ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-4599
Mailing Address - Country:US
Mailing Address - Phone:678-850-7778
Mailing Address - Fax:
Practice Address - Street 1:175 HARRIS ESTATES DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-4599
Practice Address - Country:US
Practice Address - Phone:678-850-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health