Healthcare Provider Details

I. General information

NPI: 1114495595
Provider Name (Legal Business Name): CORNERSTONE CARE COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EAST TOWNSEND STREET
NORTH LEWISBURG OH
43060-9777
US

IV. Provider business mailing address

120 EAST TOWNSEND STREET
NORTH LEWISBURG OH
43060-9777
US

V. Phone/Fax

Practice location:
  • Phone: 937-935-3028
  • Fax: 937-684-8259
Mailing address:
  • Phone: 937-935-3028
  • Fax: 937-684-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY LYNN STOKESWILLIAMS
Title or Position: OWNER
Credential: LISW-S
Phone: 937-935-3028