=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609007038
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH MARIE LUDWIG LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2009
-----------------------------------------------------
Last Update Date | 08/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1974 STATE ROAD 259
-----------------------------------------------------
City | BAKER
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26801-8745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-897-6069
-----------------------------------------------------
Fax | 304-897-6069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1974 STATE ROAD 259
-----------------------------------------------------
City | BAKER
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26801-8745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-897-6069
-----------------------------------------------------
Fax | 304-897-6069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 1943
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------