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General NPI Number Information
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NPI Number | 1003577990
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Entity Type | Individual
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Provider Name | SARAH TRENGOVE LPC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 224/92 SOI 2A KWAN WIANG MU 3 SAN PHAK WAN
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City | HANG DONG
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State | CHIANG MAI
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Zip | 50230
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Country | TH
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Telephone | 201-431-2414
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Fax |
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Provider Business Mailing Address
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Address Line | 107 E RUBY AVE APT A
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City | PALISADES PARK
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State | NJ
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Zip | 07650-2986
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Country | US
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Telephone | 201-431-2414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00808400
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License Number State | NJ
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