MEDICARE: MRS. SARAH MARIE BLACK BUDDIN M. ED, LCMHC, RPT

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	16212	NC

General Provider Information

NPI Number	:	1477138469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH MARIE BLACK BUDDIN M. ED, LCMHC, RPT

Provider Business Mailing Address
First Line	:	3824 N ELM ST STE 102
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2734
Country	:	US
Telephone Number	:	336-265-6330
Fax Number	:

Provider Business Practice Location Address
First Line	:	3824 N ELM ST STE 102
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-2734
Country	:	US
Telephone Number	:	336-265-6330
Fax Number	:

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

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	04/11/2025

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