Provider Demographics
NPI:1467727040
Name:DISIMONE, SARA LYNDSEY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNDSEY
Last Name:DISIMONE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 COOMBS FARM ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508
Mailing Address - Country:US
Mailing Address - Phone:304-241-1097
Mailing Address - Fax:
Practice Address - Street 1:3000 COOMBS FARM ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508
Practice Address - Country:US
Practice Address - Phone:304-241-1097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2085101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional