Provider Demographics
NPI:1558509646
Name:COMMONWEALTH BEHAVIORAL HEALTHCARE,LLC
Entity Type:Organization
Organization Name:COMMONWEALTH BEHAVIORAL HEALTHCARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-634-7676
Mailing Address - Street 1:307 DOGWOOD LN
Mailing Address - Street 2:STE B
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1239
Mailing Address - Country:US
Mailing Address - Phone:434-634-7676
Mailing Address - Fax:434-634-7676
Practice Address - Street 1:307 DOGWOOD LN
Practice Address - Street 2:STE B
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1239
Practice Address - Country:US
Practice Address - Phone:434-634-7676
Practice Address - Fax:434-634-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002844251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health