Provider Demographics
NPI:1457099632
Name:TACKETT, SARAH (MSED)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TACKETT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 S INDEPENDENCE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1129
Mailing Address - Country:US
Mailing Address - Phone:757-652-7213
Mailing Address - Fax:757-818-9781
Practice Address - Street 1:485 S INDEPENDENCE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1129
Practice Address - Country:US
Practice Address - Phone:757-652-7213
Practice Address - Fax:757-818-9781
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional