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General NPI Number Information
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NPI Number | 1730903162
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Entity Type | Individual
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Provider Name | SARAH SHELLEY LAC
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Gender | Female
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 63 W MAIN ST STE A-5
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City | FREEHOLD
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State | NJ
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Zip | 07728-2140
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Country | US
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Telephone | 732-810-3942
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 PAXTON LN
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City | MONROE
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State | NJ
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Zip | 08831-7308
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Country | US
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Telephone | 908-596-1360
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37AC00838300
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License Number State | NJ
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