Provider Demographics
NPI:1003184144
Name:COMMONWEALTH BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:COMMONWEALTH BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PASCAL
Authorized Official - Middle Name:
Authorized Official - Last Name:THEBAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-721-1720
Mailing Address - Street 1:PO BOX 73702
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-8045
Mailing Address - Country:US
Mailing Address - Phone:804-721-1720
Mailing Address - Fax:804-214-2177
Practice Address - Street 1:13356 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4210
Practice Address - Country:US
Practice Address - Phone:804-721-1720
Practice Address - Fax:804-214-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004809101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty