Healthcare Provider Details

I. General information

NPI: 1538434725
Provider Name (Legal Business Name): SARAH MOXLEY MS/EDS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1386 WESTGATE CENTER DR STE. G
WINSTON SALEM NC
27103-3103
US

IV. Provider business mailing address

3529 RICHS RD
BOONVILLE NC
27011-9055
US

V. Phone/Fax

Practice location:
  • Phone: 336-244-4107
  • Fax:
Mailing address:
  • Phone: 336-244-4107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7200
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: