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General NPI Number Information
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NPI Number | 1760268056
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Entity Type | Organization
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Legal Business Name | SAMPAGUITA PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 03/17/2024
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Provider Practice Location Address
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Address Line | 2712 VIRGINIA BEACH BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7615
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Country | US
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Telephone | 757-681-5606
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Fax |
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Provider Business Mailing Address
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Address Line | 2712 VIRGINIA BEACH BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7615
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Country | US
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Telephone | 757-681-5606
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER MACARAEG
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Credential | LCSW
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Telephone | 757-681-5606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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