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General NPI Number Information
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NPI Number | 1255101028
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Entity Type | Organization
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Legal Business Name | CORNERSTONE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 555 FAYETTEVILLE ST STE 201
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City | RALEIGH
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State | NC
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Zip | 27601-3034
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Country | US
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Telephone | 201-463-0017
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Fax |
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Provider Business Mailing Address
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Address Line | 555 FAYETTEVILLE ST STE 201
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City | RALEIGH
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State | NC
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Zip | 27601-3034
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Country | US
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Telephone | 201-463-0017
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LORI JACKSON-BOGLE
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Credential | PA-C
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Telephone | 201-463-0017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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