Provider Demographics
NPI:1740870435
Name:COMMONWEALTH COUNSELING GROUP LLC
Entity type:Organization
Organization Name:COMMONWEALTH COUNSELING GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:CRITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-956-0721
Mailing Address - Street 1:630 W ADAMS ST STE 403
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-1645
Mailing Address - Country:US
Mailing Address - Phone:904-966-9417
Mailing Address - Fax:904-341-5505
Practice Address - Street 1:630 W ADAMS ST STE 403
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1645
Practice Address - Country:US
Practice Address - Phone:904-966-9417
Practice Address - Fax:904-341-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty