Provider Demographics
NPI:1215203666
Name:DOMIS, SARAH WEISS (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:WEISS
Last Name:DOMIS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104.5 FORREST AVENUE
Mailing Address - Street 2:SUITE 27
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:610-664-2524
Mailing Address - Fax:
Practice Address - Street 1:104.5 FORREST AVENUE
Practice Address - Street 2:SUITE 27
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-664-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional