Provider Demographics
NPI:1891917670
Name:CORNERSTONE COUNSELING GROUP OF MANSFIELD
Entity Type:Organization
Organization Name:CORNERSTONE COUNSELING GROUP OF MANSFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:NICOL
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:419-496-4446
Mailing Address - Street 1:1221 S TRIMBLE RD
Mailing Address - Street 2:A-2
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2200
Mailing Address - Country:US
Mailing Address - Phone:419-756-0803
Mailing Address - Fax:
Practice Address - Street 1:1221 S TRIMBLE RD
Practice Address - Street 2:A-2
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2200
Practice Address - Country:US
Practice Address - Phone:419-756-0803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00088441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty