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General NPI Number Information
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NPI Number | 1467805093
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Entity Type | Organization
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Legal Business Name | LENORA BLACK
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 5215 COLLEY AVE 117
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City | NORFOLK
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State | VA
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Zip | 23508-2043
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Country | US
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Telephone | 757-831-1749
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Fax |
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Provider Business Mailing Address
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Address Line | 225 A VIEW AVE 217
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City | NORFOLK
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State | VA
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Zip | 23503-1558
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Country | US
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Telephone | 757-831-1749
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Fax |
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Authorized Official
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Title or Position | OWNER, PRACTITIONER
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Name | MS. LENORA BLACK
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Credential | LPC, NCC
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Telephone | 757-831-1749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0701006698
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License Number State | VA
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