Provider Demographics
NPI:1679830541
Name:AGAPE COUNSELING & THERAPEUTIC SERV, INC
Entity Type:Organization
Organization Name:AGAPE COUNSELING & THERAPEUTIC SERV, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING-AUTHORIZATION SPEC
Authorized Official - Prefix:
Authorized Official - First Name:TEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-244-3500
Mailing Address - Street 1:3221 COMMANDER SHEPARD BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1598
Mailing Address - Country:US
Mailing Address - Phone:757-560-1944
Mailing Address - Fax:877-468-5361
Practice Address - Street 1:3221 COMMANDER SHEPARD BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1598
Practice Address - Country:US
Practice Address - Phone:757-244-3500
Practice Address - Fax:877-468-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
VA09040049041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC284OtherMEDICARE
VA11526769OtherCAQH
VA11880856OtherCAQH
VAQ42793C284OtherMEDICARE PTAN
VA4949340Medicaid