Provider Demographics
NPI:1174578652
Name:CORNERSTONE PSYCHOLOGICAL SERVICES, PA
Entity type:Organization
Organization Name:CORNERSTONE PSYCHOLOGICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LPA
Authorized Official - Phone:336-540-9400
Mailing Address - Street 1:2711A PINEDALE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-540-9400
Mailing Address - Fax:336-540-9454
Practice Address - Street 1:2711 PINEDALE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-540-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPC0005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD1668OtherMEDCOST
NC6005300Medicaid
NC016FAOtherBCBS