Provider Demographics
NPI:1093270092
Name:RASEL, SARAH (LPES)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RASEL
Suffix:
Gender:F
Credentials:LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 RIVERS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4650
Mailing Address - Country:US
Mailing Address - Phone:843-637-4211
Mailing Address - Fax:
Practice Address - Street 1:262 RED CEDAR ST STE 4
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8968
Practice Address - Country:US
Practice Address - Phone:843-637-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4714103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool