Provider Demographics
NPI:1790139087
Name:THE CSTONE GROUP
Entity Type:Organization
Organization Name:THE CSTONE GROUP
Other - Org Name:THE CORNERSTONE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:WICHT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, CEAP
Authorized Official - Phone:601-255-7200
Mailing Address - Street 1:118 PINEHILLS DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-255-7200
Mailing Address - Fax:601-255-7200
Practice Address - Street 1:118 PINEHILLS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3314
Practice Address - Country:US
Practice Address - Phone:601-255-7200
Practice Address - Fax:601-255-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1035251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management