Basic Information
Provider Information
NPI: 1255960027
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAGGURTHI
FirstName: ESTHER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 JEFFERSON ST STE 2C
Address2:  
City: LYNCHBURG
State: VA
PostalCode: 245041724
CountryCode: US
TelephoneNumber: 2405133093
FaxNumber: 6178070958
Practice Location
Address1: 4401 E WEST HWY STE 504
Address2:  
City: BETHESDA
State: MD
PostalCode: 208144523
CountryCode: US
TelephoneNumber: 2405133093
FaxNumber: 6178070958
Other Information
ProviderEnumerationDate: 04/03/2020
LastUpdateDate: 04/03/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/03/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X  Y Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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