Provider Demographics
NPI:1407003072
Name:MARCILLE, SARA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:S
Last Name:MARCILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:335 COUNTY HOME ROAD
Mailing Address - City:WENTWORTH
Mailing Address - State:NC
Mailing Address - Zip Code:27275
Mailing Address - Country:US
Mailing Address - Phone:336-342-5756
Mailing Address - Fax:
Practice Address - Street 1:335 COUNTY HOME ROAD
Practice Address - Street 2:
Practice Address - City:WENTWORTH
Practice Address - State:NC
Practice Address - Zip Code:27275
Practice Address - Country:US
Practice Address - Phone:336-342-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0057141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical