Healthcare Provider Details

I. General information

NPI: 1902277452
Provider Name (Legal Business Name): SARAH MCLILLARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 BREMO RD SUITE 202
RICHMOND VA
23226-2400
US

IV. Provider business mailing address

5408 CHAMBERLAYNE RD SUITE 202
RICHMOND VA
23227-2407
US

V. Phone/Fax

Practice location:
  • Phone: 540-220-4820
  • Fax:
Mailing address:
  • Phone: 804-272-2000
  • Fax: 804-272-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007656
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: