MEDICARE: JONIAH DAMORNEY SAUBERAN LCMHCA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A20973	NC
2	101YM0800X	Mental Health Counselor	1571393	ID

General Provider Information

NPI Number	:	1306657820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONIAH DAMORNEY SAUBERAN LCMHCA, LPC

Provider Business Mailing Address
First Line	:	111 N LAFAYETTE ST
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N LAFAYETTE ST
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4445
Country	:	US
Telephone Number	:	980-202-0434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	02/05/2026

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