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General NPI Number Information
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NPI Number | 1669611810
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Entity Type | Organization
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Legal Business Name | CORNERSTONE COUNSELING LLC
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 2496 INDIAN SPRINGS RD
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City | MARIANNA
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State | FL
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Zip | 32446
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Country | US
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Telephone | 850-526-3227
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Fax | 866-456-9674
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Provider Business Mailing Address
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Address Line | PO BOX 6003
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City | MARIANNA
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State | FL
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Zip | 32446
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Country | US
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Telephone | 850-526-3227
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MRS. MISTI D ANDERSON
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Credential | LMHC, CAP
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Telephone | 850-526-3227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9347
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6953
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH9347
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH9988
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License Number State | FL
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