Provider Demographics
NPI:1760268056
Name:SAMPAGUITA PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:SAMPAGUITA PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MACARAEG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-681-5606
Mailing Address - Street 1:2712 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7615
Mailing Address - Country:US
Mailing Address - Phone:757-681-5606
Mailing Address - Fax:
Practice Address - Street 1:2712 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7615
Practice Address - Country:US
Practice Address - Phone:757-681-5606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904014643OtherLCSW