Provider Demographics
NPI:1295262897
Name:CENTERSTONE COUNSELING
Entity type:Organization
Organization Name:CENTERSTONE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:701-566-3922
Mailing Address - Street 1:417 38TH ST SW STE D
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6508
Mailing Address - Country:US
Mailing Address - Phone:701-566-3922
Mailing Address - Fax:701-551-7001
Practice Address - Street 1:417 38TH ST SW STE D
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6508
Practice Address - Country:US
Practice Address - Phone:701-566-3922
Practice Address - Fax:701-551-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND34981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1770741464OtherMERITCARE