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General NPI Number Information
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NPI Number | 1912938200
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH CATHOLIC CHARITIES
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1512 WILLOW LAWN DR
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City | RICHMOND
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State | VA
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Zip | 23230-3117
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Country | US
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Telephone | 804-285-5900
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Fax | 804-285-9130
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Provider Business Mailing Address
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Address Line | 1512 WILLOW LAWN DR
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City | RICHMOND
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State | VA
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Zip | 23230-3117
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Country | US
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Telephone | 804-285-5900
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Fax | 804-285-9130
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MRS. SUSAN WHITESIDE
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Credential | LCSW
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Telephone | 804-545-5951
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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 | 0904005775
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License Number State | VA
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