Provider Demographics
NPI:1679287312
Name:NEWSOME, JERRICA CHENAE (LPC)
Entity type:Individual
Prefix:
First Name:JERRICA
Middle Name:CHENAE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 COLONIAL AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1919
Mailing Address - Country:US
Mailing Address - Phone:757-937-5780
Mailing Address - Fax:757-937-5781
Practice Address - Street 1:2200 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1915
Practice Address - Country:US
Practice Address - Phone:757-937-5780
Practice Address - Fax:757-937-5781
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704011696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health