Provider Demographics
NPI:1952489171
Name:ZAGAYKO, KAREN (PHD, LCP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ZAGAYKO
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 ACWORTH DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3002
Mailing Address - Country:US
Mailing Address - Phone:804-672-1028
Mailing Address - Fax:
Practice Address - Street 1:2008 BREMO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2443
Practice Address - Country:US
Practice Address - Phone:804-673-0100
Practice Address - Fax:804-673-0100
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA393804Medicare UPIN
VA142469Medicare UPIN