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General NPI Number Information
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NPI Number | 1942796438
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Entity Type | Organization
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Legal Business Name | CORNERSTONE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 07/08/2018
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Last Update Date | 07/08/2018
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Provider Practice Location Address
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Address Line | 823 PINE ROCK AVE
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City | HAMDEN
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State | CT
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Zip | 06514-3332
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Country | US
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Telephone | 203-260-0250
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Fax |
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Provider Business Mailing Address
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Address Line | 823 PINE ROCK AVE
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City | HAMDEN
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State | CT
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Zip | 06514-3332
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Country | US
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Telephone | 203-260-0250
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | EBUN ADERIBOLE
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Credential |
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Telephone | 203-260-0250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3461
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License Number State | CT
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