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General NPI Number Information
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NPI Number | 1083305965
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Entity Type | Individual
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Provider Name | SARA INNES LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 7406 CHAPEL HILL RD STE H
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City | RALEIGH
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State | NC
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Zip | 27607-5039
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Country | US
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Telephone | 919-213-1822
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Fax |
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Provider Business Mailing Address
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Address Line | 1217 CEDAR CREEK DR
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City | CARY
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State | NC
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Zip | 27513-4948
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Country | US
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Telephone | 919-757-1115
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A18752
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License Number State | NC
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