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General NPI Number Information
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NPI Number | 1508197120
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CLINIC
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Dates
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Enumeration Date | 01/21/2010
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Last Update Date | 01/21/2010
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Provider Practice Location Address
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Address Line | 4940 EASTERN AVE JHBMC- MFL BUILDING, SUITE 353E
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City | BALTIMORE
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State | MD
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Zip | 21224-2735
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Country | US
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Telephone | 410-550-7680
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 64260
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City | BALTIMORE
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State | MD
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Zip | 21264-4260
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Country | US
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Telephone | 410-933-2063
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Fax |
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Authorized Official
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Title or Position | DIRECTOR A/R OPERATIONS
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Name | WAN-FANG TAYLOR
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Credential |
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Telephone | 410-933-2063
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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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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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