=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306384888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2017
-----------------------------------------------------
Last Update Date | 02/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1704 WINTERS HILL CIR
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23236-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-922-9548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1704 WINTERS HILL CIR
-----------------------------------------------------
City | NORTH CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23236-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-922-9548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | KE'MON BAILEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-922-9548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------