Notoriety, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904008281 Issued in VA

Legal business name

NOTORIETY, LLC

Practice address

715 E 4TH St # F28
Richmond, VA 23224-5559

Phone

(804) 901-6928

Fax

(804) 414-7733

NPI assigned

Apr 21, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Trina Bernnadette Davis-Fortune, LCSW

Title

Owner

Phone

(804) 901-6928

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398038400000",
    "number": "1033539820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 E 4TH ST # F28",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232245559",
            "telephone_number": "804-901-6928",
            "fax_number": "804-414-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 E 4TH ST # F28",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232245559",
            "telephone_number": "804-901-6928",
            "fax_number": "804-414-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOTORIETY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-21",
        "last_updated": "2014-04-21",
        "status": "A",
        "authorized_official_last_name": "DAVIS-FORTUNE",
        "authorized_official_first_name": "TRINA",
        "authorized_official_middle_name": "BERNNADETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-901-6928",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904008281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174959969",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Richmond, VA
• Providers in Richmond, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.