Provider Demographics
NPI:1396397014
Name:CAROTHERS, SARA ELIZABETH (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELIZABETH
Last Name:CAROTHERS
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 LEITCHFIELD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8306
Mailing Address - Country:US
Mailing Address - Phone:270-234-8180
Mailing Address - Fax:270-234-8179
Practice Address - Street 1:2645 LEITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8306
Practice Address - Country:US
Practice Address - Phone:270-234-8180
Practice Address - Fax:270-234-8179
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168441101YM0800X, 101YA0400X
KY5051101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional