Provider Demographics
NPI:1740570621
Name:COMMONWEALTH CLINICAL & CONSULTING SERVICES
Entity Type:Organization
Organization Name:COMMONWEALTH CLINICAL & CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-922-1189
Mailing Address - Street 1:8021 HEAVENLY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-8955
Mailing Address - Country:US
Mailing Address - Phone:804-922-1189
Mailing Address - Fax:
Practice Address - Street 1:3122 W MARSHALL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4726
Practice Address - Country:US
Practice Address - Phone:804-447-2729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty