Provider Demographics
NPI:1235142944
Name:SAVAGE, STEPHANIE (LPC, LSATP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 WASHINGTON AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4327
Mailing Address - Country:US
Mailing Address - Phone:757-245-0217
Mailing Address - Fax:757-245-4918
Practice Address - Street 1:400 MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1767
Practice Address - Country:US
Practice Address - Phone:757-788-0400
Practice Address - Fax:757-788-0957
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002765101YP2500X
VA0718000024101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-45573Medicaid
VAC03714Medicare ID - Type UnspecifiedGROUP MEDICARE