Provider Demographics
NPI:1083063051
Name:HAASE, SARAH (LPC, LPCC, CCMHC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:HAASE
Suffix:
Gender:F
Credentials:LPC, LPCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BAKER ST UNIT 463
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4595
Mailing Address - Country:US
Mailing Address - Phone:404-375-1300
Mailing Address - Fax:
Practice Address - Street 1:125 BAKER ST UNIT 463
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4595
Practice Address - Country:US
Practice Address - Phone:404-375-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008246101YP2500X
CA9835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional