Organization
SUPPORTONE INC
Active
Other names
Community-Based Services, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CASSANDRA PETTUS SCARBOROUGH CPA (EXECUTIVE DIRECTOR)
(804) 340-1845
Entity
Organization
Contact information
Practice address
3500 KENSINGTON AVE STE B, RICHMOND, VA 23221-2144
(804) 342-7366
(804) 342-7368
Mailing address
2100 W LABUMUM AVE, SUITE 104-B, RICHMOND, VA 23227
(804) 340-1845
(804) 340-1848
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
323
VA
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
323-01-0001
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004948271
—
VA
Enumeration date
07/09/2006
Last updated
08/29/2017
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