Provider Demographics
NPI:1023383890
Name:MAYBOUER, SARA ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH
Last Name:MAYBOUER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PAVILION WAY STE E7
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-4559
Mailing Address - Country:US
Mailing Address - Phone:910-585-2167
Mailing Address - Fax:910-705-4847
Practice Address - Street 1:100 PAVILION WAY STE E7
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4559
Practice Address - Country:US
Practice Address - Phone:910-585-2167
Practice Address - Fax:910-705-4847
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3255103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4063679OtherDRIVERS LICENSE