Healthcare Provider Details

I. General information

NPI: 1639655657
Provider Name (Legal Business Name): SARAH DAVIDSON COCOWITCH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S COLLEGE AVE
SALEM VA
24153-5165
US

IV. Provider business mailing address

2601 WYCLIFFE AVE SW
ROANOKE VA
24014-2335
US

V. Phone/Fax

Practice location:
  • Phone: 540-387-3955
  • Fax:
Mailing address:
  • Phone: 415-810-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701007783
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: