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General NPI Number Information
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NPI Number | 1265305759
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Entity Type | Organization
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Legal Business Name | CORNERSTONE LICENSED CLINICAL SOCIAL WORKER, INC.
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 3810 BROADWAY
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City | SACRAMENTO
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State | CA
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Zip | 95817-3302
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Country | US
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Telephone | 916-204-1447
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Fax |
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Provider Business Mailing Address
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Address Line | 2443 FAIR OAKS BLVD # 1060
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City | SACRAMENTO
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State | CA
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Zip | 95825-7684
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Country | US
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Telephone | 916-204-1447
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TATIANA STARR DANIELS
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Credential | LCSW
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Telephone | 916-514-7073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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