Healthcare Provider Details

I. General information

NPI: 1376434712
Provider Name (Legal Business Name): SARA GOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10737 REIVERSIDE DRIVE
NORTH HOLLYWOOD CA
91602
US

IV. Provider business mailing address

4821 LANKERSHIM BLVD # F124
NORTH HOLLYWOOD CA
91601-4538
US

V. Phone/Fax

Practice location:
  • Phone: 747-345-1163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17635
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: