=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861119877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARA MAYS LCSW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2022
-----------------------------------------------------
Last Update Date | 10/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 528 STATE ST
-----------------------------------------------------
City | CURWENSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16833-1124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-577-0569
-----------------------------------------------------
Fax | 814-690-2099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1348 GRICE RD
-----------------------------------------------------
City | OLANTA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16863-8013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-577-0569
-----------------------------------------------------
Fax | 814-690-2099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ CLINICIAN
-----------------------------------------------------
Name | SARA MAYS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 814-577-0569
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------