Provider Demographics
NPI:1124564216
Name:EDWARDS, SARA DOMINICA (MED, MED, LPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:DOMINICA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MED, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W BROAD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5570
Mailing Address - Country:US
Mailing Address - Phone:657-235-2656
Mailing Address - Fax:
Practice Address - Street 1:227 W BROAD ST STE 104
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5570
Practice Address - Country:US
Practice Address - Phone:657-235-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CO0018361101YP2500X
NMCTB-2022-0210101YP2500X
NJ37PC00932000101YP2500X
PAPC011605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor