Provider Demographics
NPI:1497421077
Name:DAVIS, SARAH HAGAN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:HAGAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 EDDIE MASSEY LN
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-0026
Mailing Address - Country:US
Mailing Address - Phone:478-804-1542
Mailing Address - Fax:
Practice Address - Street 1:1565 EBENEZER RD STE 210
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3625
Practice Address - Country:US
Practice Address - Phone:478-804-1542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
7194OtherNONE