Provider Demographics
NPI:1508578469
Name:HERTS, SADIE (LPC)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:HERTS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2202 EXECUTIVE DR STE C
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6604
Mailing Address - Country:US
Mailing Address - Phone:757-827-7707
Mailing Address - Fax:757-838-2573
Practice Address - Street 1:2202 EXECUTIVE DR STE C
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6604
Practice Address - Country:US
Practice Address - Phone:757-827-7707
Practice Address - Fax:757-838-2573
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional