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General NPI Number Information
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NPI Number | 1033281084
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Entity Type | Organization
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Legal Business Name | CORNERSTONE COUNSELING CENTER
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 526 N MAIN ST
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City | CENTERVILLE
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State | IA
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Zip | 52544-1432
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Country | US
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Telephone | 641-856-2606
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Fax |
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Provider Business Mailing Address
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Address Line | 526 N MAIN ST
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City | CENTERVILLE
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State | IA
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Zip | 52544-1432
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Country | US
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Telephone | 641-856-2606
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | ANGELA S. ELLISON
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Credential | R.N.
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Telephone | 641-856-2606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | IA
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