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General NPI Number Information
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NPI Number | 1033321237
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Entity Type | Organization
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Legal Business Name | CORNERSTONE SERVICE INTERVENTION SYSTEMS
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 4620 HAYGOOD RD STE 6
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5401
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Country | US
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Telephone | 757-464-2470
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Fax |
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Provider Business Mailing Address
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Address Line | 4620 HAYGOOD RD STE 6
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5401
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Country | US
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Telephone | 757-464-2470
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. WALTER LEWIS STONE JR.
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Credential | MS
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Telephone | 757-464-2470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 915 05 001
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License Number State | VA
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