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General NPI Number Information
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NPI Number | 1215820329
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Entity Type | Organization
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Legal Business Name | COMMUNITY CONNECTORS LLC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 318 E WASHINGTON ST
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City | PETERSBURG
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State | VA
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Zip | 23803-4314
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Country | US
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Telephone | 804-387-3818
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 COVINGTON RD
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2714
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Country | US
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Telephone | 804-387-3818
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PAMELA BANKS
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Credential | LPC, SAP, LSATP
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Telephone | 804-387-3818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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