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General NPI Number Information
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NPI Number | 1144157223
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Entity Type | Organization
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Legal Business Name | CORNERSTONE HEALTH & WELLNESS CLINIC OF TENNESSEE
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 10634 THREE WISHES DR
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-8753
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Country | US
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Telephone | 901-406-6705
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Fax |
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Provider Business Mailing Address
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Address Line | 10634 THREE WISHES DR
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-8753
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Country | US
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Telephone | 901-406-6705
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | ANGELICA LUCAS
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Credential | LMSW
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Telephone | 901-406-6705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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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 |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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