Provider Demographics
NPI:1588132534
Name:PENNEY, SARA (LCMHC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PENNEY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 RAMSEY ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7658
Mailing Address - Country:US
Mailing Address - Phone:910-580-9346
Mailing Address - Fax:910-229-3622
Practice Address - Street 1:4140 RAMSEY ST STE 108
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-7658
Practice Address - Country:US
Practice Address - Phone:910-580-9346
Practice Address - Fax:910-229-3622
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24864101YA0400X
NC14456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty