Provider Demographics
NPI:1174850614
Name:CORNERSTONE COUNSELING LLC
Entity Type:Organization
Organization Name:CORNERSTONE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MISTI ANDERSON OR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLITA SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP
Authorized Official - Phone:850-526-3227
Mailing Address - Street 1:2496 INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-3140
Mailing Address - Country:US
Mailing Address - Phone:850-526-3227
Mailing Address - Fax:
Practice Address - Street 1:2496 INDIAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-3140
Practice Address - Country:US
Practice Address - Phone:850-526-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP3431; CAP3669101YA0400X
FLMH9988; MH9347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000889900Medicaid
FL768925000Medicaid