Healthcare Provider Details

I. General information

NPI: 1326551565
Provider Name (Legal Business Name): SARA LYNN BEATSON CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MARION PIKE STE 3
COAL GROVE OH
45638
US

IV. Provider business mailing address

323 MARION PIKE STE 3
COAL GROVE OH
45638-2958
US

V. Phone/Fax

Practice location:
  • Phone: 740-646-6640
  • Fax: 866-475-7263
Mailing address:
  • Phone: 740-646-6640
  • Fax: 866-475-7263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.164308
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: