Organization
COMMONWEALTH COUNSELING ASSOCIATES INC
Active
Other names
LifeStance Health
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PARDO (CHIEF LEGAL OFFICER)
(206) 399-1493
Entity
Organization
Contact information
Practice address
9202 CENTER OAK CT, MECHANICSVILLE, VA 23116-2744
(804) 207-6737
(804) 730-2829
Mailing address
9202 CENTER OAK CT, MECHANICSVILLE, VA 23116-2744
(804) 207-6737
(804) 730-2829
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
270615000
MAGELLAN
—
05
—
30015185590001
—
VA
01
—
440241
ANTHEM BCBS
VA
Enumeration date
05/22/2006
Last updated
02/15/2024
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