Healthcare Provider Details

I. General information

NPI: 1467001966
Provider Name (Legal Business Name): SARAH BOSTON CSAC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. SARAH WILLIS/ THOMPSON-WILLIS

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 OLD GREENBRIER RD STE B
CHESAPEAKE VA
23320-2619
US

IV. Provider business mailing address

11111 SAN JOSE BLVD SUITE 56 BOX# 1270
JACKSONVILLE FL
32223-7274
US

V. Phone/Fax

Practice location:
  • Phone: 757-702-3282
  • Fax:
Mailing address:
  • Phone: 347-326-4541
  • Fax: 888-811-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC200002406
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701013179
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC17363
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710103413
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20034
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: