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General NPI Number Information
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NPI Number | 1407672165
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Entity Type | Individual
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Provider Name | SARAH JEAN FORD LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 4819 EMPEROR BLVD STE 400
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City | DURHAM
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State | NC
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Zip | 27703-5420
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Country | US
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Telephone | 919-756-6116
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Fax |
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Provider Business Mailing Address
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Address Line | 8216 PILOTS VIEW DR
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City | RALEIGH
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State | NC
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Zip | 27617-8712
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Country | US
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Telephone | 919-345-2559
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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 | A20825
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License Number State | NC
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