MEDICARE: COMMUNITY INVOLVEMENT SERVICES. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1437005071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY INVOLVEMENT SERVICES. LLC

Provider Business Mailing Address
First Line	:	401 ROBERTS AVE APT 910
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2478
Country	:	US
Telephone Number	:	804-618-4942
Fax Number	:	804-618-4942

Provider Business Practice Location Address
First Line	:	401 ROBERTS AVE APT 910
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2478
Country	:	US
Telephone Number	:	804-618-4942
Fax Number	:	804-618-4942

Authorized Official
Title or Position	:	OWNER
Name	:	TAMARA RENEE WYCHE
Credential	:
Telephone Number	:	804-618-4942

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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