Provider Demographics
NPI:1285093013
Name:BLACK, MELANIE (LPC)
Entity type:Individual
Prefix:
First Name:MELANIE
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 1:2900 KENSINGTON AVE
Mailing Address - Street 2:APT 214
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2473
Mailing Address - Country:US
Mailing Address - Phone:804-908-2385
Mailing Address - Fax:
Practice Address - Street 1:2002 BREMO RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2400
Practice Address - Country:US
Practice Address - Phone:804-908-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional