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General NPI Number Information
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NPI Number | 1265921803
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Entity Type | Organization
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Legal Business Name | SARAH J GAUTHIER LLC
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 708 MOBJACK PL
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1957
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Country | US
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Telephone | 757-873-1958
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Fax |
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Provider Business Mailing Address
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Address Line | 201 SAINT LO CT
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-1543
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Country | US
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Telephone | 757-788-6260
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARAH JANE GAUTHIER
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Credential | DCLINPSYCH
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Telephone | 757-788-6260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005954
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License Number State | VA
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