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Organization
STRANGE FRUIT PSYCHOTHERAPY LLC
Active
Organization
STRANGE FRUIT PSYCHOTHERAPY LLC
Active
Other names
Strange Fruit Psychotherapy
Organization subpart
No
Provider details
NPI number
Authorized official
SHERVONNE EVETTE BANKS LCSW (LICENSED CLINICAL SOCIAL WORKER)
(757) 240-7928
Entity
Organization
Contact information
Practice address
1204 E PEMBROKE AVE, HAMPTON, VA 23669-3226
(757) 240-7928
Mailing address
110 COLISEUM XING, HAMPTON, VA 23666-5971
(757) 240-7928
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033398003
—
VA
Enumeration date
10/31/2022
Last updated
10/31/2022
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