Provider Demographics
NPI:1386370716
Name:CORNERSTONE COMMUNITY COUNSELING LLC
Entity type:Organization
Organization Name:CORNERSTONE COMMUNITY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIKKI
Authorized Official - Middle Name:LACHELLE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-C
Authorized Official - Phone:313-355-2286
Mailing Address - Street 1:15499 BRAILE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1609
Mailing Address - Country:US
Mailing Address - Phone:313-575-8383
Mailing Address - Fax:
Practice Address - Street 1:14400 PURITAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-2966
Practice Address - Country:US
Practice Address - Phone:313-355-2286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty