Healthcare Provider Details

I. General information

NPI: 1063237444
Provider Name (Legal Business Name): CORNERSTONE COUNSELING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CANTON ST FL 2
TROY PA
16947-1452
US

IV. Provider business mailing address

3237 MOUNTAIN RIDGE RD
MAINESBURG PA
16932-9517
US

V. Phone/Fax

Practice location:
  • Phone: 570-512-0164
  • Fax:
Mailing address:
  • Phone: 570-512-0164
  • Fax: 888-848-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DIANA HOLTON
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 570-512-0164