Healthcare Provider Details

I. General information

NPI: 1639350499
Provider Name (Legal Business Name): SARAH A NOLAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 CAPITAL BLVD
WAKE FOREST NC
27587-4513
US

IV. Provider business mailing address

11130 CAPITAL BLVD
WAKE FOREST NC
27587-4513
US

V. Phone/Fax

Practice location:
  • Phone: 919-488-0015
  • Fax: 919-488-0021
Mailing address:
  • Phone: 919-488-0015
  • Fax: 919-488-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005247
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierC005247
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerLCSW NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: