Healthcare Provider Details

I. General information

NPI: 1932573359
Provider Name (Legal Business Name): SARAH DANIELLE CAMPAGNA FAGAN MA, NCC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH DANIELLE CAMPAGNA MA, NCC, LCMHC

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1862 ELLIOT FARM RD
FAYETTEVILLE NC
28311-9739
US

IV. Provider business mailing address

1862 ELLIOT FARM RD
FAYETTEVILLE NC
28311-9739
US

V. Phone/Fax

Practice location:
  • Phone: 910-429-5050
  • Fax:
Mailing address:
  • Phone: 910-429-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11797
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: