Provider Demographics
NPI:1437795945
Name:COMMONWEALTH COUNSELING AGENCY LLC
Entity Type:Organization
Organization Name:COMMONWEALTH COUNSELING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, QMHP
Authorized Official - Phone:757-652-3280
Mailing Address - Street 1:138 S ROSEMONT RD STE 208
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4336
Mailing Address - Country:US
Mailing Address - Phone:757-652-3280
Mailing Address - Fax:757-707-8565
Practice Address - Street 1:138 S ROSEMONT RD STE 208
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4336
Practice Address - Country:US
Practice Address - Phone:757-652-3280
Practice Address - Fax:757-707-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3283Medicaid