Healthcare Provider Details

I. General information

NPI: 1073209904
Provider Name (Legal Business Name): CORNERSTONE CHRISTIAN COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PASEO REYES DR
ST AUGUSTINE FL
32095-8464
US

IV. Provider business mailing address

3609 S WADSWORTH BLVD STE 132
LAKEWOOD CO
80235-2106
US

V. Phone/Fax

Practice location:
  • Phone: 904-439-4400
  • Fax: 303-484-3943
Mailing address:
  • Phone: 303-902-3068
  • Fax: 303-484-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SEAN F TAYLOR
Title or Position: CO-FOUNDER, CEO
Credential: LMFT, CAC
Phone: 303-902-3068