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General NPI Number Information
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NPI Number | 1619900511
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Entity Type | Individual
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Provider Name | SARA R ROSE PH.D., LPC
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1515 MOCKINGBIRD LN SUITE 411
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City | CHARLOTTE
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State | NC
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Zip | 28209-3236
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Country | US
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Telephone | 704-525-1213
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Fax | 704-525-1213
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Provider Business Mailing Address
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Address Line | 3426 GRESHAM PL
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City | CHARLOTTE
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State | NC
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Zip | 28211-3966
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Country | US
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Telephone | 704-525-1213
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Fax | 704-525-1213
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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 | 755
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License Number State | NC
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