Healthcare Provider Details

I. General information

NPI: 1811659634
Provider Name (Legal Business Name): CORNERSTONE CENTERS FOR WELLBEING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 LANE PARK RD
TAVARES FL
32778-9648
US

IV. Provider business mailing address

2445 LANE PARK RD
TAVARES FL
32778-9648
US

V. Phone/Fax

Practice location:
  • Phone: 866-742-6655
  • Fax:
Mailing address:
  • Phone: 866-742-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL BUCCIARELLI
Title or Position: VP, LEGAL SERVICES
Credential:
Phone: 813-871-8075