Healthcare Provider Details

I. General information

NPI: 1861159972
Provider Name (Legal Business Name): SARAH HARTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 COSHOCTON AVE
MOUNT VERNON OH
43050-1900
US

IV. Provider business mailing address

118 MARITA DR
MOUNT VERNON OH
43050-2970
US

V. Phone/Fax

Practice location:
  • Phone: 740-326-6110
  • Fax: 800-480-7578
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.180310
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: