Healthcare Provider Details

I. General information

NPI: 1053433615
Provider Name (Legal Business Name): CATHERINE SACKS, LCSW, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 ROSE HILL DR SUITE 201
CHARLOTTESVILLE VA
22903-5159
US

IV. Provider business mailing address

1110 ROSE HILL DR SUITE 201
CHARLOTTESVILLE VA
22903-5159
US

V. Phone/Fax

Practice location:
  • Phone: 434-979-0401
  • Fax: 434-220-3335
Mailing address:
  • Phone: 434-979-0401
  • Fax: 434-220-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002205
License Number StateVA

VIII. Authorized Official

Name: MRS. CATHERINE SACKS
Title or Position: OWNER
Credential: LCSW
Phone: 434-979-0401