Provider Demographics
NPI:1588432843
Name:COMMONWEALTH SUPPORTIVE SERVICES,LLC
Entity type:Organization
Organization Name:COMMONWEALTH SUPPORTIVE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAPALL
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:804-988-6768
Mailing Address - Street 1:16 S 2ND ST STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3723
Mailing Address - Country:US
Mailing Address - Phone:804-566-2049
Mailing Address - Fax:
Practice Address - Street 1:16 S 2ND ST STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3723
Practice Address - Country:US
Practice Address - Phone:804-566-2049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health