Healthcare Provider Details

I. General information

NPI: 1689229361
Provider Name (Legal Business Name): SARA SIMPSON THOMAS LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date: 04/27/2023
Reactivation Date: 05/25/2023

III. Provider practice location address

11 E LEXINGTON ST STE 400
BALTIMORE MD
21202-1723
US

IV. Provider business mailing address

450 E LORRAINE AVE
BALTIMORE MD
21218-4712
US

V. Phone/Fax

Practice location:
  • Phone: 443-708-5699
  • Fax:
Mailing address:
  • Phone: 803-556-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: