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General NPI Number Information
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NPI Number | 1508409152
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Entity Type | Organization
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Legal Business Name | OBSIDIAN COUNSELING AND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 10/25/2019
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 6387 CENTER DR STE 19
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City | NORFOLK
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State | VA
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Zip | 23502-4109
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Country | US
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Telephone | 757-453-3051
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Fax |
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Provider Business Mailing Address
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Address Line | 857 GEORGE WASHINGTON HWY N UNIT 6991
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City | CHESAPEAKE
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State | VA
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Zip | 23323-1362
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Country | US
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Telephone | 757-453-3051
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER/LPC
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Name | NATASHA BECKUM
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Credential | LPC
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Telephone | 757-453-3051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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