Provider Demographics
NPI:1104449123
Name:GEORGE, SARAH ELIZABETH (MS, LAC)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 WOODLANE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-3832
Mailing Address - Country:US
Mailing Address - Phone:707-333-4893
Mailing Address - Fax:
Practice Address - Street 1:795 WOODLANE RD STE 301
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-3832
Practice Address - Country:US
Practice Address - Phone:707-333-4893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00472800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health