| Cornerstone Centers For Wellbeing, Llc | |
|
2445 Lane Park Rd Tavares FL 32778-9648 | |
| (866) 742-6655 | |
| Not Available |
| Full Name | Cornerstone Centers For Wellbeing, Llc |
|---|---|
| Speciality | Counselor |
| Location | 2445 Lane Park Rd, Tavares, Florida |
| Authorized Official Name and Position | Charles O Lee (MANAGER) |
| Authorized Official Contact | 8667426655 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornerstone Centers For Wellbeing, Llc 2445 Lane Park Rd Tavares FL 32778-9648 Ph: (866) 742-6655 | Cornerstone Centers For Wellbeing, Llc 2445 Lane Park Rd Tavares FL 32778-9648 Ph: (866) 742-6655 |
| NPI Number | 1811659634 |
|---|---|
| Provider Enumeration Date | 10/08/2021 |
| Last Update Date | 10/08/2021 |
| Certification Date | 10/08/2021 |
| Medicare PECOS PAC ID | 9739574880 |
|---|---|
| Medicare Enrollment ID | O20220328001222 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811659634 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kristen J Hopper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477894343 PECOS PAC ID: 3274881891 Enrollment ID: I20180730001876 |
| Provider Name | Janelle Carbone-rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396332458 PECOS PAC ID: 4688088958 Enrollment ID: I20210127002475 |
| Provider Name | Melissa M Sandberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841592284 PECOS PAC ID: 0648452789 Enrollment ID: I20240126001556 |
| Provider Name | Chareece Reynolds Hall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871923029 PECOS PAC ID: 5092158337 Enrollment ID: I20240203000346 |
| Provider Name | Enos Kenville Butler |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1700508595 PECOS PAC ID: 9436592615 Enrollment ID: I20240205001419 |
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