Provider Demographics
NPI:1043358419
Name:CORNERSTONE COMPREHENSIVE SERVICES
Entity Type:Organization
Organization Name:CORNERSTONE COMPREHENSIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARRISSE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SOMME
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:336-760-0700
Mailing Address - Street 1:1303 ASHLEYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2918
Mailing Address - Country:US
Mailing Address - Phone:336-760-0700
Mailing Address - Fax:336-760-0007
Practice Address - Street 1:1303 ASHLEYBROOK LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2918
Practice Address - Country:US
Practice Address - Phone:336-760-0700
Practice Address - Fax:336-760-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8301205251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301205Medicaid