Provider Demographics
NPI:1467001966
Name:BOSTON, SARAH (CSAC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:BOSTON
Suffix:
Gender:F
Credentials:CSAC, LMHC
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:WILLIS/ THOMPSON-WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11595 DUNNS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-9341
Mailing Address - Country:US
Mailing Address - Phone:347-326-4541
Mailing Address - Fax:
Practice Address - Street 1:2010 OLD GREENBRIAR RD, SUITE G
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-493-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103413101YA0400X
FLMH20034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty