MEDICARE: AGAPE COUNSELING & THERAPEUTIC SERV, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1679830541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE COUNSELING & THERAPEUTIC SERV, INC

Provider Business Mailing Address
First Line	:	3221 COMMANDER SHEPARD BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1598
Country	:	US
Telephone Number	:	757-560-1944
Fax Number	:	877-468-5361

Provider Business Practice Location Address
First Line	:	3221 COMMANDER SHEPARD BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1598
Country	:	US
Telephone Number	:	757-244-3500
Fax Number	:	877-468-5361

Authorized Official
Title or Position	:	CREDENTIALING-AUTHORIZATION SPEC
Name	:	TEISHA SPARROW
Credential	:
Telephone Number	:	757-244-3500

Provider Enumeration Date	:	04/17/2012
Last Update Date	:	02/08/2021

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