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General NPI Number Information
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NPI Number | 1366774846
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Entity Type | Organization
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Legal Business Name | CORNERSTONE COUNSELING SERVICE LLC
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 102 E LAFAYETTE ST
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City | MONTICELLO
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State | IL
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Zip | 61856-1954
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Country | US
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Telephone | 217-433-6109
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Fax |
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Provider Business Mailing Address
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Address Line | 102 E LAFAYETTE ST
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City | MONTICELLO
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State | IL
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Zip | 61856-1954
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Country | US
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Telephone | 217-433-6109
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAMES D EDWARDS
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Credential | LCSW
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Telephone | 217-433-6109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149-006656
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License Number State | IL
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