Healthcare Provider Details

I. General information

NPI: 1154909216
Provider Name (Legal Business Name): SARA LACARIA-HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 CARNATION CIR
MYRTLE BEACH SC
29577-8774
US

IV. Provider business mailing address

4860 CARNATION CIR
MYRTLE BEACH SC
29577-8774
US

V. Phone/Fax

Practice location:
  • Phone: 304-774-5788
  • Fax:
Mailing address:
  • Phone: 304-774-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number512
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: