Healthcare Provider Details

I. General information

NPI: 1346514262
Provider Name (Legal Business Name): SAGACITY CONSULTATIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 FIRST COLONIAL RD SUITE 102-A
VIRGINIA BEACH VA
23451-6106
US

IV. Provider business mailing address

PO BOX 7558
ARLINGTON VA
22207-0558
US

V. Phone/Fax

Practice location:
  • Phone: 877-879-7655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810001848
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007185
License Number StateVA

VIII. Authorized Official

Name: JAMES POLK
Title or Position: PRESIDENT/DIRECTOR
Credential:
Phone: 877-879-7655