NPIMap

Organization Active NPI

Black Pine Counseling Center

Doing business as Black Pine Counseling

  • Professional Counselor
  • Newport News, VA
National Provider Identifier
1578014395
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
701006460 Issued in VA
Legal business name
BLACK PINE COUNSELING CENTER
Doing business as
Black Pine Counseling
Practice address
727 J Clyde Morris Blvd Ste a
Newport News, VA 23601
Phone
(757) 595-3455
Fax
(757) 595-3456
NPI assigned
Oct 17, 2016
Last updated
Aug 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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

Authorized official

Name
Mark Nichols, MA, LPCNPI 1275879785
Title
Director
Phone
(757) 595-3455

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 701006460 VA Primary

Addresses

Primary practice location

727 J Clyde Morris Blvd Ste a
Newport News, VA 23601

Mailing address

727 J Clyde Morris Blvd Ste a
Newport News, VA 23601-1507
Phone (757) 595-3455

Other identifiers 1

IdentifierTypeStateIssuer
701006460OtherVASTATE LICENSE

Other names 1

  • Black Pine Counseling Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181003001823 VA Part B Supplier - Clinic/Group Practice 0345592226 Receives reassigned benefits from 7 practitioners
Practice locations: Newport News, VA

National Provider Directory

National Provider Directory

Locations

760 Pilot House Dr
Ste E
Newport News, VA 23606
Phone (757) 595-3455

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1578014395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 J CLYDE MORRIS BLVD STE A",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236011507",
            "telephone_number": "757-595-3455",
            "fax_number": "757-595-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 J CLYDE MORRIS BLVD STE A",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "23601",
            "telephone_number": "757-595-3455",
            "fax_number": "757-595-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK PINE COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "757-595-3455",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "701006460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "701006460",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black Pine Counseling",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Black Pine Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.