Healthcare Provider Details

I. General information

NPI: 1881933596
Provider Name (Legal Business Name): SARAH LOMBARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 12/06/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9812 FOXHALL WAY UNIT 3
ESTERO FL
33928-3089
US

IV. Provider business mailing address

9812 FOXFHALL
ESTERO FL
33928-3117
US

V. Phone/Fax

Practice location:
  • Phone: 239-850-9078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00573900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: