Healthcare Provider Details

I. General information

NPI: 1154239390
Provider Name (Legal Business Name): LAUREN GREY SAPKO-FENTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 BLUE CEDAR DR
CHESTERFIELD VA
23832-2452
US

IV. Provider business mailing address

7601 BLUE CEDAR DR
CHESTERFIELD VA
23832-2452
US

V. Phone/Fax

Practice location:
  • Phone: 804-814-5256
  • Fax:
Mailing address:
  • Phone: 804-814-5256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019930
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: