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General NPI Number Information
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NPI Number | 1346514262
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Entity Type | Organization
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Legal Business Name | SAGACITY CONSULTATIONS PLLC
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 840 FIRST COLONIAL RD SUITE 102-A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6106
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Country | US
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Telephone | 877-879-7655
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7558
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City | ARLINGTON
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State | VA
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Zip | 22207-0558
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | JAMES POLK
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Credential |
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Telephone | 877-879-7655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007185
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810001848
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License Number State | VA
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