Provider Demographics
NPI:1275091688
Name:ROTHACHER, SARAH LEIGH (CDCA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LEIGH
Last Name:ROTHACHER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 E IRON AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2030
Mailing Address - Country:US
Mailing Address - Phone:330-343-5555
Mailing Address - Fax:330-365-3765
Practice Address - Street 1:897 E IRON AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2030
Practice Address - Country:US
Practice Address - Phone:330-343-5555
Practice Address - Fax:330-365-3765
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166157101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)