Provider Demographics
NPI:1134148380
Name:AGAPE COUNSELING & THERAPEUTIC SERVICES, INC
Entity type:Organization
Organization Name:AGAPE COUNSELING & THERAPEUTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING 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:757-244-3500
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:2006-07-19
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YP2500X, 103TC0700X, 103TH0004X, 104100000X, 1041C0700X, 172V00000X, 261QM0855X, 251S00000X
VA0904004904101YM0800X, 1041C0700X, 251S00000X
VA09040025841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ59697C284OtherMEDICARE PTAN
VA13953971OtherCAQH
VA11526769OtherCAQH
VA8936358Medicaid
VAQ42793C284OtherMEDICAARE PTAN
VAQ46363C284OtherMEDICARE PTAN