MEDICARE: SERINA MARIE PANGELINAN LPC, MS IN CMHC

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	0701015053	VA
2	101YM0800X	Mental Health Counselor	0701015053	VA

General Provider Information

NPI Number	:	1780427310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERINA MARIE PANGELINAN LPC, MS IN CMHC

Provider Business Mailing Address
First Line	:	3501 CORUM DR APT 1211
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-8941
Country	:	US
Telephone Number	:	804-332-4279
Fax Number	:

Provider Business Practice Location Address
First Line	:	10611 PATTERSON AVE STE 301
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23238-4733
Country	:	US
Telephone Number	:	804-592-1611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	07/16/2025

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