Healthcare Provider Details

I. General information

NPI: 1639551500
Provider Name (Legal Business Name): COMMON HEALTH COUNSELING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 PATTERSON AVE # C-21
HENRICO VA
23238-5101
US

IV. Provider business mailing address

10431 PATTERSON AVE # C-21
HENRICO VA
23238-5101
US

V. Phone/Fax

Practice location:
  • Phone: 804-590-4852
  • Fax: 804-730-1953
Mailing address:
  • Phone: 804-730-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KENDRICK KELLY
Title or Position: CEO
Credential:
Phone: 804-730-1932