Provider Demographics
NPI:1932447281
Name:CORNERSTONE COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:CORNERSTONE COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-206-4411
Mailing Address - Street 1:1890 S 14TH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4740
Mailing Address - Country:US
Mailing Address - Phone:904-206-4411
Mailing Address - Fax:904-206-4433
Practice Address - Street 1:1890 S 14TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4740
Practice Address - Country:US
Practice Address - Phone:904-206-4411
Practice Address - Fax:904-206-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC7684251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health