Provider Demographics
NPI:1508042409
Name:CORNERSTONE CHRISTIAN COUNSELING LLC
Entity type:Organization
Organization Name:CORNERSTONE CHRISTIAN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARZOFKA
Authorized Official - Suffix:
Authorized Official - Credentials:MS LCSW
Authorized Official - Phone:715-923-8105
Mailing Address - Street 1:3110 GILBERT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1934
Mailing Address - Country:US
Mailing Address - Phone:715-923-8105
Mailing Address - Fax:
Practice Address - Street 1:3110 GILBERT ST
Practice Address - Street 2:SUITE A
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1934
Practice Address - Country:US
Practice Address - Phone:715-923-8105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2716251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42251900Medicaid