Provider Demographics
NPI:1114683372
Name:SAGEFORTH PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SAGEFORTH PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:SAGEFORTH PSYCHOLOGICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MAHNAZ
Authorized Official - Last Name:VANLANDINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-777-7755
Mailing Address - Street 1:552 FORT EVANS RD STE 206
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3378
Mailing Address - Country:US
Mailing Address - Phone:703-777-7755
Mailing Address - Fax:
Practice Address - Street 1:552 FORT EVANS RD STE 206
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3378
Practice Address - Country:US
Practice Address - Phone:703-777-7755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty