Provider Demographics
NPI:1942016365
Name:COMMON HEALTH COUNSELING GROUP, LLC
Entity type:Organization
Organization Name:COMMON HEALTH COUNSELING GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-730-1932
Mailing Address - Street 1:10431 PATTERSON AVE # C-21
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5101
Mailing Address - Country:US
Mailing Address - Phone:804-730-1932
Mailing Address - Fax:804-730-1953
Practice Address - Street 1:10431 PATTERSON AVE # C-21
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-5101
Practice Address - Country:US
Practice Address - Phone:804-730-1932
Practice Address - Fax:804-730-1953
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMON HEALTH COUNSELING GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities