Provider Demographics
NPI:1225467947
Name:SMITH, SARAH SHEALY (EDS, LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SHEALY
Last Name:SMITH
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RAVENWING CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-0914
Mailing Address - Country:US
Mailing Address - Phone:803-413-0021
Mailing Address - Fax:
Practice Address - Street 1:5211 N TRENHOLM RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4815
Practice Address - Country:US
Practice Address - Phone:803-413-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional