Provider Demographics
NPI:1780427310
Name:PANGELINAN, SERINA MARIE (MS CMHC)
Entity type:Individual
Prefix:
First Name:SERINA
Middle Name:MARIE
Last Name:PANGELINAN
Suffix:
Gender:F
Credentials:MS CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CORUM DR APT 1211
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-8941
Mailing Address - Country:US
Mailing Address - Phone:804-332-4279
Mailing Address - Fax:
Practice Address - Street 1:3957 WESTERRE PKWY STE 208
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1319
Practice Address - Country:US
Practice Address - Phone:804-844-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015818101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional