Healthcare Provider Details

I. General information

NPI: 1164916763
Provider Name (Legal Business Name): MISS SARAH WHIDDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4714 38TH PL N
ARLINGTON VA
22207-2915
US

IV. Provider business mailing address

4714 38TH PL N
ARLINGTON VA
22207-2915
US

V. Phone/Fax

Practice location:
  • Phone: 571-345-6543
  • Fax:
Mailing address:
  • Phone: 571-345-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: