Provider Demographics
NPI:1346645645
Name:MOSS, SARA (CAC III)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3854 W PRINCETON CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3111
Mailing Address - Country:US
Mailing Address - Phone:720-789-9936
Mailing Address - Fax:
Practice Address - Street 1:3854 W PRINCETON CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3111
Practice Address - Country:US
Practice Address - Phone:720-789-9936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC 0006581101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)