Healthcare Provider Details

I. General information

NPI: 1780702233
Provider Name (Legal Business Name): CORNERSTONE COUNSELING OF ASHLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 CLAREMONT AVE
ASHLAND OH
44805-3010
US

IV. Provider business mailing address

502 CLAREMONT AVE
ASHLAND OH
44805-3010
US

V. Phone/Fax

Practice location:
  • Phone: 419-289-1876
  • Fax: 419-281-6430
Mailing address:
  • Phone: 419-289-1876
  • Fax: 419-281-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH PORTNER
Title or Position: OWNER PRESIDENT
Credential: LPCC
Phone: 419-289-1876