MEDICARE: MELANIE BLACK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701006497	VA

General Provider Information

NPI Number	:	1285093013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE BLACK LPC

Provider Business Mailing Address
First Line	:	2900 KENSINGTON AVE
Second Line	:	APT 214
City	:	RICHMOND
State	:	VA
Zip	:	23221-2473
Country	:	US
Telephone Number	:	804-908-2385
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 BREMO RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2400
Country	:	US
Telephone Number	:	804-908-2385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	02/22/2016

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