Provider Demographics
NPI:1215412903
Name:PENCE, SARAH (CDPT CO 60657676)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PENCE
Suffix:
Gender:F
Credentials:CDPT CO 60657676
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11708 ELDER AVE SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-7740
Mailing Address - Country:US
Mailing Address - Phone:360-551-7116
Mailing Address - Fax:
Practice Address - Street 1:6625 WAGNER WAY STE 320
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8392
Practice Address - Country:US
Practice Address - Phone:253-858-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60657676101YA0400X
WALH61556179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)