Organization
BLACK PINE COUNSELING CENTER
Active
Other names
Black Pine Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
MARK NICHOLS MA, LPC (DIRECTOR)
(757) 595-3455
Entity
Organization
Contact information
Practice address
727 J CLYDE MORRIS BLVD STE A, NEWPORT NEWS, VA 23601
(757) 595-3455
(757) 595-3456
Mailing address
727 J CLYDE MORRIS BLVD STE A, NEWPORT NEWS, VA 23601-1507
(757) 595-3455
(757) 595-3456
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
701006460
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
701006460
STATE LICENSE
VA
Enumeration date
10/17/2016
Last updated
08/25/2021
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