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Organization
COMMONWEALTH GLOBAL
Active
Organization
COMMONWEALTH GLOBAL
Active
Other names
Commonwealth Behavioral
Organization subpart
No
Provider details
NPI number
Authorized official
KIRSTEN AMANDA WALLACE CEO (CHIEF EXECUTIVE OFFICE)
(818) 651-4594
Entity
Organization
Contact information
Practice address
22231 MULHOLLAND HWY STE 211, CALABASAS, CA 91302-5179
(818) 651-4594
Mailing address
22231 MULHOLLAND HWY STE 211, CALABASAS, CA 91302-5179
(818) 651-4594
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
190809AN
CA
320800000X
Mental Illness Community Based Residential Treatment Facility
190808AN
—
324500000X
Substance Abuse Rehabilitation Facility
190809AN
—
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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