Healthcare Provider Details

I. General information

NPI: 1255076170
Provider Name (Legal Business Name): SARAH ACKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 DUKE ST # 111
PRINCE FREDERICK MD
20678-6128
US

IV. Provider business mailing address

65 DUKE ST # 111
PRINCE FREDERICK MD
20678-6128
US

V. Phone/Fax

Practice location:
  • Phone: 443-247-5061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: