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General NPI Number Information
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NPI Number | 1851578793
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Entity Type | Organization
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Legal Business Name | CORNERSTONE COUNSELING OF CHARLOTTE, PC
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 1916 COMMONWEALTH AVE
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City | CHARLOTTE
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State | NC
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Zip | 28205-5020
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Country | US
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Telephone | 704-375-2336
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Fax |
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Provider Business Mailing Address
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Address Line | 1916 COMMONWEALTH AVE
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City | CHARLOTTE
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State | NC
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Zip | 28205-5020
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Country | US
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Telephone | 704-375-2336
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MS. ALLISON ANNE CROTTY
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Credential | LCSW
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Telephone | 704-375-0033
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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 | C004407
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License Number State | NC
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Legacy Identifiers
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Identifier #1
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Identifier Code | 6002686
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Identifier Type | MEDICAID
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Identifier State | NC
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 6002686
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Identifier Type | MEDICAID
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Identifier State | NC
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Identifier Issuer |
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