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General NPI Number Information
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NPI Number | 1811659634
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CENTERS FOR WELLBEING, LLC
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 2445 LANE PARK RD
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City | TAVARES
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State | FL
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Zip | 32778-9648
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Country | US
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Telephone | 866-742-6655
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Fax |
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Provider Business Mailing Address
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Address Line | 2445 LANE PARK RD
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City | TAVARES
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State | FL
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Zip | 32778-9648
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Country | US
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Telephone | 866-742-6655
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Fax |
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Authorized Official
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Title or Position | VP, LEGAL SERVICES
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Name | CRYSTAL BUCCIARELLI
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Credential |
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Telephone | 813-871-8075
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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 |
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License Number State |
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