MEDICARE: CORNERSTONES FOR LIFE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1053041368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONES FOR LIFE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1172
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-1172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	524S. HOUSTON LAKE RD.
Second Line	:	BLDG .B SUITE 100
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-8211
Country	:	US
Telephone Number	:	478-542-0832
Fax Number	:	478-245-9080

Authorized Official
Title or Position	:	OWNER
Name	:	FREEDOM BOWERS
Credential	:	LMFT
Telephone Number	:	704-609-7474

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/05/2024

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Directions to “CORNERSTONES FOR LIFE, LLC ” Practice Location

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