Provider Demographics
NPI:1114495595
Name:CORNERSTONE CARE COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:CORNERSTONE CARE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STOKESWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:937-935-3028
Mailing Address - Street 1:120 EAST TOWNSEND STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43060-9777
Mailing Address - Country:US
Mailing Address - Phone:937-935-3028
Mailing Address - Fax:937-684-8259
Practice Address - Street 1:120 EAST TOWNSEND STREET
Practice Address - Street 2:
Practice Address - City:NORTH LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:43060-9777
Practice Address - Country:US
Practice Address - Phone:937-935-3028
Practice Address - Fax:937-684-8259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty