Organization
CORNERSTONE COMMUNITY COUNSELING CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA MARIE RAY MRC, LPC (CEO)
(870) 869-1500
Entity
Organization
Contact information
Practice address
609 W 3RD ST, IMBODEN, AR 72434-9099
(870) 869-1500
(870) 869-1505
Mailing address
609 W 3RD ST, IMBODEN, AR 72434-9099
(870) 869-1500
(870) 869-1505
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164272526
—
AR
05
—
172732526
—
AR
Enumeration date
04/10/2007
Last updated
03/27/2012
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