Provider Demographics
NPI:1457960585
Name:CORNERSTONE COUNSELING SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:CORNERSTONE COUNSELING SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BEVILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-956-4106
Mailing Address - Street 1:10947 NW 56TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3112
Mailing Address - Country:US
Mailing Address - Phone:434-956-4106
Mailing Address - Fax:
Practice Address - Street 1:5571 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4653
Practice Address - Country:US
Practice Address - Phone:434-956-4106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty