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General NPI Number Information
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NPI Number | 1508526245
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Entity Type | Organization
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Legal Business Name | CORNERSTONE FAMILY WORSHIP CENTER
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 1918 W 5TH ST
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City | WASHINGTON
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State | NC
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Zip | 27889-9095
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Country | US
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Telephone | 252-946-6109
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1763
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City | WASHINGTON
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State | NC
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Zip | 27889-1763
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Country | US
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Telephone | 252-946-6109
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | SHIRLEY ROBERSON
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Credential |
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Telephone | 252-946-6109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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