Provider Demographics
NPI:1508190026
Name:EISENHAUER, SARAH LYNN (MA)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:LYNN
Last Name:EISENHAUER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2701
Mailing Address - Country:US
Mailing Address - Phone:828-669-4161
Mailing Address - Fax:828-669-4164
Practice Address - Street 1:932 OLD US 70 W
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-2547
Practice Address - Country:US
Practice Address - Phone:828-669-4161
Practice Address - Fax:828-669-4164
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2567OtherNORTH CAROLINA SUBSTANCE ABUSE PROFESSIONAL PRACTICE BOARD