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General NPI Number Information
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NPI Number | 1386370716
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Entity Type | Organization
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Legal Business Name | CORNERSTONE COMMUNITY COUNSELING LLC
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 14400 PURITAN ST
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City | DETROIT
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State | MI
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Zip | 48227-2966
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Country | US
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Telephone | 313-355-2286
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Fax |
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Provider Business Mailing Address
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Address Line | 15499 BRAILE ST
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City | DETROIT
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State | MI
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Zip | 48223-1609
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Country | US
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Telephone | 313-575-8383
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MRS. MIKKI LACHELLE MASON
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Credential | LMSW-C
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Telephone | 313-355-2286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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