Provider Demographics
NPI:1942574413
Name:SACKETT, VIRGINIA LOUISE (LCSW, EDD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LOUISE
Last Name:SACKETT
Suffix:
Gender:F
Credentials:LCSW, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SHELTON MCMURPHEY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5015
Mailing Address - Country:US
Mailing Address - Phone:541-210-8090
Mailing Address - Fax:
Practice Address - Street 1:150 SHELTON MCMURPHEY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5015
Practice Address - Country:US
Practice Address - Phone:541-210-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL65811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500668331Medicaid