Healthcare Provider Details

I. General information

NPI: 1053215483
Provider Name (Legal Business Name): SARAH ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 VIRGINIA AVE
CUMBERLAND MD
21502-4501
US

IV. Provider business mailing address

308 VIRGINIA AVE
CUMBERLAND MD
21502-4501
US

V. Phone/Fax

Practice location:
  • Phone: 667-600-2567
  • Fax:
Mailing address:
  • Phone: 667-600-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP18639
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: