Healthcare Provider Details

I. General information

NPI: 1538317003
Provider Name (Legal Business Name): SARAH LITTLEBEAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 RIVER PARK NORTH DR
WOODSTOCK GA
30188
US

IV. Provider business mailing address

205 RIVER PARK NORTH DR
WOODSTOCK GA
30188-7835
US

V. Phone/Fax

Practice location:
  • Phone: 770-468-6231
  • Fax: 770-672-7694
Mailing address:
  • Phone: 770-468-6231
  • Fax: 770-672-7694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: