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General NPI Number Information
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NPI Number | 1508042409
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CHRISTIAN COUNSELING LLC
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 3110 GILBERT ST SUITE A
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City | MARINETTE
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State | WI
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Zip | 54143-1934
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Country | US
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Telephone | 715-923-8105
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Fax |
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Provider Business Mailing Address
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Address Line | 3110 GILBERT ST SUITE A
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City | MARINETTE
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State | WI
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Zip | 54143-1934
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Country | US
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Telephone | 715-923-8105
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MS. LAURIE ANN MARZOFKA
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Credential | MS LCSW
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Telephone | 715-923-8105
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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 | 2716
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License Number State | WI
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