Provider Demographics
NPI:1033668603
Name:THE COLLABORATIVE GOOD, LLC
Entity Type:Organization
Organization Name:THE COLLABORATIVE GOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:PILAR
Authorized Official - Last Name:PINA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-974-7037
Mailing Address - Street 1:2308 MOUNT VERNON AVE
Mailing Address - Street 2:#123
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1328
Mailing Address - Country:US
Mailing Address - Phone:718-974-7037
Mailing Address - Fax:
Practice Address - Street 1:133 PARK ST NE
Practice Address - Street 2:#3B
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4666
Practice Address - Country:US
Practice Address - Phone:718-974-7037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09030023631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty