Provider Demographics
NPI:1528664646
Name:SAGACITY GLOBAL PSYCH AND ASSOCIATES
Entity type:Organization
Organization Name:SAGACITY GLOBAL PSYCH AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:443-527-7678
Mailing Address - Street 1:2563 WOODLAKE RD SW APT 6
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4718
Mailing Address - Country:US
Mailing Address - Phone:443-527-7678
Mailing Address - Fax:
Practice Address - Street 1:2563 WOODLAKE RD SW APT 6
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4718
Practice Address - Country:US
Practice Address - Phone:443-527-7678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty