Provider Demographics
NPI:1316000573
Name:MOORE-HINES, SARA (LPC)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:MOORE-HINES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2225
Mailing Address - Country:US
Mailing Address - Phone:610-626-3127
Mailing Address - Fax:610-626-0114
Practice Address - Street 1:320 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2225
Practice Address - Country:US
Practice Address - Phone:610-626-3127
Practice Address - Fax:610-626-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000705101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional