Provider Demographics
NPI:1962026203
Name:GASAWAY, SARAH (LAC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GASAWAY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:ATKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:P. O. BOX 251970
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1970
Mailing Address - Country:US
Mailing Address - Phone:501-666-8686
Mailing Address - Fax:501-660-6830
Practice Address - Street 1:6601 WEST 12TH STREET
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1513
Practice Address - Country:US
Practice Address - Phone:501-666-8686
Practice Address - Fax:501-660-6829
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2303013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health