Provider Demographics
NPI:1811439946
Name:CORNERSTONE COUNSELING CENTER OF CHICAGO
Entity type:Organization
Organization Name:CORNERSTONE COUNSELING CENTER OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL TRAINING
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-573-8860
Mailing Address - Street 1:1111 N WELLS ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7635
Mailing Address - Country:US
Mailing Address - Phone:312-573-8860
Mailing Address - Fax:312-275-7922
Practice Address - Street 1:1111 N WELLS ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7635
Practice Address - Country:US
Practice Address - Phone:312-573-8860
Practice Address - Fax:312-275-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health