Cornerstone Psychological Center

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY001267 Issued in GA

Legal business name

CORNERSTONE PSYCHOLOGICAL CENTER

Practice address

1897 Godby Rd
College Park, GA 30349-5235

Phone

(770) 996-7622

Fax

(770) 996-5469

NPI assigned

Jan 10, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sherry L Blake, PHD

Title

Ceo

Phone

(770) 996-7622

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326153600000",
    "number": "1467722397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1897 GODBY RD",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495235",
            "telephone_number": "770-996-7622",
            "fax_number": "770-996-5469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1897 GODBY RD",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495235",
            "telephone_number": "770-996-7622",
            "fax_number": "770-996-5469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE PSYCHOLOGICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-10",
        "last_updated": "2012-01-10",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-996-7622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY001267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.