MEDICARE: CHRISTINA MARIE SANCHEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor	0701012986	VA

General Provider Information

NPI Number	:	1376204446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE SANCHEZ

Provider Business Mailing Address
First Line	:	113 ACKISS AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-5805
Country	:	US
Telephone Number	:	570-369-0340
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 ACKISS AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-5805
Country	:	US
Telephone Number	:	570-369-0340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2021
Last Update Date	:	08/01/2024

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