Provider Demographics
NPI:1730639196
Name:BLACK, LENORA (LPC)
Entity Type:Individual
Prefix:MS
First Name:LENORA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 A VIEW AVE APT 217
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-1558
Mailing Address - Country:US
Mailing Address - Phone:757-831-1749
Mailing Address - Fax:
Practice Address - Street 1:5215 COLLEY AVE
Practice Address - Street 2:117
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2043
Practice Address - Country:US
Practice Address - Phone:757-321-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006698101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health