Provider Demographics
NPI:1194005504
Name:THOMAS, SARAH (MA, LAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8603 E EASTRIDGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8562
Mailing Address - Country:US
Mailing Address - Phone:928-777-3280
Mailing Address - Fax:928-717-1660
Practice Address - Street 1:8603 E EASTRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8562
Practice Address - Country:US
Practice Address - Phone:928-777-3280
Practice Address - Fax:928-717-1660
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-13471101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor