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Organization
NOTORIETY, LLC
Active
Organization
NOTORIETY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRINA BERNNADETTE DAVIS-FORTUNE LCSW (OWNER)
(804) 901-6928
Entity
Organization
Contact information
Practice address
715 E 4TH ST # F28, RICHMOND, VA 23224-5559
(804) 901-6928
(804) 414-7733
Mailing address
715 E 4TH ST # F28, RICHMOND, VA 23224-5559
(804) 901-6928
(804) 414-7733
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904008281
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174959969
—
VA
Enumeration date
04/21/2014
Last updated
04/21/2014
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