Organization
CORNERSTONE RESTORATION AND TRAINING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLIS O. HENDERSON ED.D, M.DIV (OWNER)
(804) 852-7645
Entity
Organization
Contact information
Practice address
1700 BLAIR ST, RICHMOND, VA 23220-6406
(804) 852-7645
Mailing address
4411 WISTAR RD, HENRICO, VA 23228-2640
(804) 852-7645
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0904006909
VA
Other
Enumeration date
06/09/2017
Last updated
06/20/2018
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