Provider Demographics
NPI:1164451068
Name:GEWANTER, SARAH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:GEWANTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 BOYD RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-9208
Mailing Address - Country:US
Mailing Address - Phone:828-683-6900
Mailing Address - Fax:828-683-0303
Practice Address - Street 1:690 BOYD RD
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748-9208
Practice Address - Country:US
Practice Address - Phone:828-683-6900
Practice Address - Fax:828-683-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0033091041C0700X, 104100000X
CT0005031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131JJOtherBLUECROSS BLUE SHEILD
CT131JJOtherBLUECROSS BLUE SHIELD
NC6002376Medicaid
CT800000070Medicare PIN