MEDICARE: MS. SARAH KATHERINE AXLEY LCSW

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	1041C0700X	Clinical Social Worker	0904008055	VA

General Provider Information

NPI Number	:	1457604597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH KATHERINE AXLEY LCSW

Provider Business Mailing Address
First Line	:	1201 BROAD ROCK BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-4915
Country	:	US
Telephone Number	:	804-675-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 HULL ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-4072
Country	:	US
Telephone Number	:	804-230-0999
Fax Number	:	804-230-0998

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

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	07/23/2014

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