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General NPI Number Information
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NPI Number | 1003210899
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Entity Type | Organization
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Legal Business Name | CORNERSTONE COUNSELING
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 15292 DUNCAN CANYON RD
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City | FONTANA
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State | CA
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Zip | 92336-1210
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Country | US
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Telephone | 909-543-4959
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Fax | 909-899-9937
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Provider Business Mailing Address
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Address Line | 7147 RIVA PL
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-8725
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Country | US
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Telephone | 909-543-4959
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MOIRA M CONLEY-JACKSON
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Credential | M.F.T.
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Telephone | 909-559-8148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC38902
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License Number State | CA
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