Provider Demographics
NPI:1932945912
Name:COMMON CARE THERAPEUTIC LLC
Entity type:Organization
Organization Name:COMMON CARE THERAPEUTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:SABASTON
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:804-714-4563
Mailing Address - Street 1:2211 CHATEAU DR APT H
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2734
Mailing Address - Country:US
Mailing Address - Phone:804-714-4563
Mailing Address - Fax:
Practice Address - Street 1:2211 CHATEAU DR APT H
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2734
Practice Address - Country:US
Practice Address - Phone:804-714-4563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health