Provider Demographics
NPI:1124348040
Name:ROSS, SARA JANE (EDS, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:JANE
Last Name:ROSS
Suffix:
Gender:F
Credentials:EDS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NC
Mailing Address - Zip Code:27840-0250
Mailing Address - Country:US
Mailing Address - Phone:252-798-5631
Mailing Address - Fax:
Practice Address - Street 1:306 S. HORTON ST.
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NC
Practice Address - Zip Code:27840-0250
Practice Address - Country:US
Practice Address - Phone:252-798-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool