Provider Demographics
NPI:1538348701
Name:CORNERSTONE PSYCHOLOGICAL SEVICES INC.
Entity type:Organization
Organization Name:CORNERSTONE PSYCHOLOGICAL SEVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-255-2043
Mailing Address - Street 1:129 MAIN ST STE 406
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4615
Mailing Address - Country:US
Mailing Address - Phone:304-255-2043
Mailing Address - Fax:304-255-2043
Practice Address - Street 1:129 MAIN ST STE 406
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4615
Practice Address - Country:US
Practice Address - Phone:304-255-2043
Practice Address - Fax:304-255-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV757103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty