Provider Demographics
NPI:1104197169
Name:ELLIOTT, SARAH M (LCMHC/S, LCAS, CSI)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LCMHC/S, LCAS, CSI
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:MOORING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC/S, LCAS, CSI
Mailing Address - Street 1:2018 EASTWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-620-5328
Mailing Address - Fax:910-777-5273
Practice Address - Street 1:3825 MARKET ST STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1426
Practice Address - Country:US
Practice Address - Phone:910-777-5575
Practice Address - Fax:910-777-5273
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8993101YM0800X, 101YP2500X
NCLCAS1666101YA0400X, 101YA0400X
NCLPC8993101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)