Provider Demographics
NPI:1194842831
Name:COMMONWEALTH MENTAL HEALYH ASSOCIATES
Entity type:Organization
Organization Name:COMMONWEALTH MENTAL HEALYH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUTKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-913-3503
Mailing Address - Street 1:8322 TRAFORD LN # D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1668
Mailing Address - Country:US
Mailing Address - Phone:703-913-3503
Mailing Address - Fax:703-913-1193
Practice Address - Street 1:8322 TRAFORD LN
Practice Address - Street 2:D
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1668
Practice Address - Country:US
Practice Address - Phone:703-913-3503
Practice Address - Fax:703-913-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty