MEDICARE: SANDBRIDGE THERAPY & WELLNESS, LLC

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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962202812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDBRIDGE THERAPY & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	2397 LIBERTY WAY STE 103
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3464
Country	:	US
Telephone Number	:	757-230-5584
Fax Number	:

Provider Business Practice Location Address
First Line	:	2397 LIBERTY WAY STE 103
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-3464
Country	:	US
Telephone Number	:	757-230-5584
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	MRS. AMANDA STULL
Credential	:	LPC-R
Telephone Number	:	757-230-5584

Provider Enumeration Date	:	03/18/2025
Last Update Date	:	07/22/2025

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