MEDICARE: CORNERSTONE COUNSELING OF CHARLOTTE, PC

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	101YM0800X	Mental Health Counselor	C004407	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851578793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE COUNSELING OF CHARLOTTE, PC

Provider Business Mailing Address
First Line	:	1916 COMMONWEALTH AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-5020
Country	:	US
Telephone Number	:	704-375-2336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 COMMONWEALTH AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-5020
Country	:	US
Telephone Number	:	704-375-2336
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MS. ALLISON ANNE CROTTY
Credential	:	LCSW
Telephone Number	:	704-375-0033

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	01/22/2008

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