| Black Pine Counseling | |
|
727 J Clyde Morris Blvd Ste A Newport News VA 23601 | |
| (757) 595-3455 | |
| (757) 595-3456 |
| Full Name | Black Pine Counseling |
|---|---|
| Speciality | Counselor |
| Location | 727 J Clyde Morris Blvd Ste A, Newport News, Virginia |
| Authorized Official Name and Position | Mark Nichols (DIRECTOR) |
| Authorized Official Contact | 7575953455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Pine Counseling 727 J Clyde Morris Blvd Ste A Newport News VA 23601-1507 Ph: (757) 595-3455 | Black Pine Counseling 727 J Clyde Morris Blvd Ste A Newport News VA 23601 Ph: (757) 595-3455 |
| NPI Number | 1578014395 |
|---|---|
| Provider Enumeration Date | 10/17/2016 |
| Last Update Date | 08/25/2021 |
| Certification Date | 08/25/2021 |
| Medicare PECOS PAC ID | 0345592226 |
|---|---|
| Medicare Enrollment ID | O20181003001823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578014395 | NPI | - | NPPES |
| 701006460 | Other | VA | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 701006460 (Virginia) | Primary |
| Provider Name | Donna Lynn Searle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649517137 PECOS PAC ID: 6507001674 Enrollment ID: I20130320000085 |
| Provider Name | Edith G Moorcones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891418307 PECOS PAC ID: 6204203557 Enrollment ID: I20221031000962 |
| Provider Name | Ellen Goodloe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558075341 PECOS PAC ID: 6002265311 Enrollment ID: I20231212003249 |
| Provider Name | Aishah Khursheed |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1538789425 PECOS PAC ID: 4981055605 Enrollment ID: I20240108000764 |
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