Provider Demographics
NPI:1003907130
Name:CHILDRESS, SARAH C (MED)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:C
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:VAUEHAN
Other - Last Name:CHAMBLEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 S LOUDOUN STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-667-5431
Mailing Address - Fax:540-667-2655
Practice Address - Street 1:801 S LOUDOUN STREET
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-667-5431
Practice Address - Fax:540-667-2655
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0803000056103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA077570OtherANTHEM BCBS
VA088749OtherCOMMUNITY HEALTH