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General NPI Number Information
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NPI Number | 1023488665
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CHRISTIAN COUNSELING
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 1759 NORTH 25 STREET
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City | MIDDLESBORO
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State | KY
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Zip | 40965
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Country | US
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Telephone | 865-585-6618
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1511
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City | MIDDLESBORO
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State | KY
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Zip | 40965-3311
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Country | US
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Telephone | 865-585-6681
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACOB LEWIS
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Credential | L.P.C.C
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Telephone | 865-585-6681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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