Healthcare Provider Details

I. General information

NPI: 1386060960
Provider Name (Legal Business Name): SARA BOYCHAK MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA LYNN LAUGHTON BSW

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 ANDREWS RD STE 130
DURHAM NC
27705-2993
US

IV. Provider business mailing address

411 ANDREWS RD STE 130
DURHAM NC
27705-2993
US

V. Phone/Fax

Practice location:
  • Phone: 919-682-5777
  • Fax:
Mailing address:
  • Phone: 919-682-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP009225
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC 60482075
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: