Provider Demographics
NPI:1003173659
Name:GOGUEN, SARA CHARLES (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CHARLES
Last Name:GOGUEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 SURREYWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2157
Mailing Address - Country:US
Mailing Address - Phone:704-378-1390
Mailing Address - Fax:704-378-1392
Practice Address - Street 1:2125 SOUTHEND DR
Practice Address - Street 2:SUITE 452
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5301
Practice Address - Country:US
Practice Address - Phone:704-378-1390
Practice Address - Fax:704-378-1392
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0076721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical