Shannon Trice Black, PH.D., LPC
Individual provider Active NPI Mental Health Counselor · Manakin Sabot, VA
NPI 1528448271 · NPPES record last updated Nov 28, 2016
Key facts
- NPI
- 1528448271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 0701003122 (VA)
- Practice address
- 1900 Manakin Rd Ste G
Manakin Sabot, VA 23103-2252 - Phone
- (804) 305-4642
- Fax
- (804) 556-3624
- NPI assigned
- Jun 8, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Chesterfield Family Guidance Center
Practice addresses (Care Compare)
11520 Nuckols Rd
Suite 102
Glen Allen, VA 23059-2558
Phone (804) 743-0960
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260508001154 | VA | Practitioner - Mental Health Counselor | 2668837964 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0701003122 | VA | Yes |
Addresses
Primary practice location
1900 Manakin Rd Ste G
Manakin Sabot, VA 23103-2252
Mailing address
1900 Manakin Rd
Suite G
Manakin Sabot, VA 23103-2252
Phone (804) 305-4642
Other providers in Manakin Sabot, VA
- Jennifer S Aaron
- Deborah Atherholt
- Jaclyn Banerjee
- Melissa M Bowers
- Angela Shelton Brooks
- Eric R. Carlsen
- Callie A. Carter
- Centerville Cardinal Drug Center Inc
All providers in Manakin Sabot, VA · Mental Health Counselor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.