Provider Demographics
NPI:1093292153
Name:FAGGERT, SARAH DAWN (DAC, LAC)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:DAWN
Last Name:FAGGERT
Suffix:
Gender:F
Credentials:DAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11017 BYRD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5331
Mailing Address - Country:US
Mailing Address - Phone:804-955-0156
Mailing Address - Fax:
Practice Address - Street 1:1497 CHAIN BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5728
Practice Address - Country:US
Practice Address - Phone:571-354-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000890171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist