Provider Demographics
NPI:1023840329
Name:SPORT PSYCHS LLC
Entity type:Organization
Organization Name:SPORT PSYCHS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ SPORT PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-476-4065
Mailing Address - Street 1:8401 GREENSBORO DR STE 550
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-5146
Mailing Address - Country:US
Mailing Address - Phone:703-679-8249
Mailing Address - Fax:
Practice Address - Street 1:8401 GREENSBORO DR STE 550
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-5146
Practice Address - Country:US
Practice Address - Phone:703-679-8249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Single Specialty