Provider Demographics
NPI:1821341652
Name:COMMUNITY INTERVENTION ASSOCIATES LLC
Entity Type:Organization
Organization Name:COMMUNITY INTERVENTION ASSOCIATES LLC
Other - Org Name:MINDSET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:804-386-2338
Mailing Address - Street 1:4906 CUTSHAW AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3630
Mailing Address - Country:US
Mailing Address - Phone:804-386-2338
Mailing Address - Fax:
Practice Address - Street 1:4906 CUTSHAW AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230
Practice Address - Country:US
Practice Address - Phone:804-386-2338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health