Healthcare Provider Details

I. General information

NPI: 1760268056
Provider Name (Legal Business Name): SAMPAGUITA PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-7615
US

IV. Provider business mailing address

2712 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-7615
US

V. Phone/Fax

Practice location:
  • Phone: 757-681-5606
  • Fax:
Mailing address:
  • Phone: 757-681-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MACARAEG
Title or Position: OWNER
Credential: LCSW
Phone: 757-681-5606