MEDICARE: LENORA BLACK

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	251S00000X	Community/Behavioral Health Agency	0701006698	VA

General Provider Information

NPI Number	:	1467805093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LENORA BLACK

Provider Business Mailing Address
First Line	:	225 A VIEW AVE
Second Line	:	217
City	:	NORFOLK
State	:	VA
Zip	:	23503-1558
Country	:	US
Telephone Number	:	757-831-1749
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 COLLEY AVE
Second Line	:	117
City	:	NORFOLK
State	:	VA
Zip	:	23508-2043
Country	:	US
Telephone Number	:	757-831-1749
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PRACTITIONER
Name	:	MS. LENORA BLACK
Credential	:	LPC, NCC
Telephone Number	:	757-831-1749

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	07/19/2016

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Directions to “LENORA BLACK ” Practice Location

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