Provider Demographics
NPI:1710202213
Name:DESAI, SAMPADA R (LPC)
Entity Type:Individual
Prefix:
First Name:SAMPADA
Middle Name:R
Last Name:DESAI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 SUMMERPARK DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2763
Mailing Address - Country:US
Mailing Address - Phone:434-316-7292
Mailing Address - Fax:434-316-7292
Practice Address - Street 1:1224 SUMMERPARK DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2763
Practice Address - Country:US
Practice Address - Phone:434-316-7292
Practice Address - Fax:434-316-7292
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003170101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional