Provider Demographics
NPI:1417716754
Name:VAVRA, SARA TREXLER (LCMHCA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:TREXLER
Last Name:VAVRA
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3206
Mailing Address - Country:US
Mailing Address - Phone:704-571-4021
Mailing Address - Fax:
Practice Address - Street 1:7301 CARMEL EXECUTIVE PARK DR STE 330
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4200
Practice Address - Country:US
Practice Address - Phone:704-780-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health