MEDICARE: SARA WILSON MARTIN MFT

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	106H00000X	Marriage & Family Therapist	1781	NC

General Provider Information

NPI Number	:	1396457891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA WILSON MARTIN MFT

Provider Business Mailing Address
First Line	:	PO BOX 5541
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-0541
Country	:	US
Telephone Number	:	803-616-6786
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 WILLIAMSON RD STE 204
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-7611
Country	:	US
Telephone Number	:	855-542-8255
Fax Number	:

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

Provider Enumeration Date	:	12/16/2022
Last Update Date	:	12/16/2022

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Directions to “ SARA WILSON MARTIN MFT” Practice Location

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