Provider Demographics
NPI:1962202812
Name:SANDBRIDGE THERAPY & WELLNESS, LLC
Entity type:Organization
Organization Name:SANDBRIDGE THERAPY & WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STULL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-R
Authorized Official - Phone:757-230-5584
Mailing Address - Street 1:2397 LIBERTY WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3464
Mailing Address - Country:US
Mailing Address - Phone:757-230-5584
Mailing Address - Fax:
Practice Address - Street 1:2397 LIBERTY WAY STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3464
Practice Address - Country:US
Practice Address - Phone:757-230-5584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDBRIDGE THERAPY & WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-18
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3001820567Medicaid