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General NPI Number Information
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NPI Number | 1760711550
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Entity Type | Organization
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Legal Business Name | TRINITY COMMONWEALTH GROUP LLC
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 1913 HUGUENOT RD SUITE 301
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City | RICHMOND
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State | VA
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Zip | 23235-4329
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Country | US
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Telephone | 804-893-3176
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Fax |
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Provider Business Mailing Address
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Address Line | 1913 HUGUENOT RD SUITE 301
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City | RICHMOND
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State | VA
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Zip | 23235-4329
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Country | US
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Telephone | 804-893-3176
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Fax |
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Authorized Official
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Title or Position | CAO
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Name | MS. DIONE FIELDS
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Credential |
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Telephone | 804-893-3176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 128905001
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License Number State | VA
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