Provider Demographics
NPI:1013375831
Name:CORNERSTONE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:CORNERSTONE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON-LONGLET
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-266-3422
Mailing Address - Street 1:111 E MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9780
Mailing Address - Country:US
Mailing Address - Phone:989-266-3422
Mailing Address - Fax:989-266-3197
Practice Address - Street 1:111 E MIDLAND RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9780
Practice Address - Country:US
Practice Address - Phone:989-266-3422
Practice Address - Fax:989-266-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010714361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty