| Doctor Name: | MS. MARISA GWALTNEY CORNELL |
| NPI Number: | 1063533826 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BS |
| License Number: | |
| Business Practice Address: | 318 Donnelly St Mountain City, TN - 376831510 |
| Business Phone Number: | 4237272100 |
| Business Fax Number: | 4237272110 |
| Mailing Address: | Po Box 9054, GRAY |
| State: | TN |
| Postal Code: | 376159054 |
| Phone Number: | 4234673600 |
| Fax Number: | 4234673644 |
| NPI Enumeration Date: | 04/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |