Healthcare Provider Details

I. General information

NPI: 1093564650
Provider Name (Legal Business Name): LEMICH CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 COLLEY AVE
NORFOLK VA
23508-2043
US

IV. Provider business mailing address

5205 COLLEY AVE
NORFOLK VA
23508-2043
US

V. Phone/Fax

Practice location:
  • Phone: 757-536-1233
  • Fax: 757-734-7194
Mailing address:
  • Phone: 757-536-1233
  • Fax: 757-734-7194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: GREGORY LEMICH
Title or Position: CEO
Credential: PHD, LPC
Phone: 757-536-1233