Healthcare Provider Details
I. General information
NPI: 1962026203
Provider Name (Legal Business Name): SARAH GASAWAY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 06/02/2020
Last Update Date: 06/06/2025
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6601 WEST 12TH STREET
LITTLE ROCK AR
72204-1513
US
IV. Provider business mailing address
P. O. BOX 251970
LITTLE ROCK AR
72225-1970
US
V. Phone/Fax
- Phone: 501-666-8686
- Fax: 501-660-6829
- Phone: 501-666-8686
- Fax: 501-660-6830
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | P2503025 |
| License Number State | AR |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | A2303013 |
| License Number State | AR |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: