MEDICARE: COMMITTED COUNSELING PROGRAM

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	253Z00000X	In Home Supportive Care Agency	1593	VA

General Provider Information

NPI Number	:	1548518293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMITTED COUNSELING PROGRAM

Provider Business Mailing Address
First Line	:	2317 WESTWOOD AVE
Second Line	:	STE#208
City	:	RICHMOND
State	:	VA
Zip	:	23230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2317 WESTWOOD AVE
Second Line	:	SUITE # 208
City	:	RICHMOND
State	:	VA
Zip	:	23230-4007
Country	:	US
Telephone Number	:	804-901-9588
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MUHAMMAD ALAMIN
Credential	:
Telephone Number	:	804-901-9588

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	08/28/2012

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