Provider Demographics
NPI:1518002054
Name:PHILLIPS, SARA MOORHEAD (LCMFT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MOORHEAD
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3871 SPENCER CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4945
Mailing Address - Country:US
Mailing Address - Phone:410-988-5231
Mailing Address - Fax:
Practice Address - Street 1:8182 LARK BROWN RD
Practice Address - Street 2:STE 201
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6428
Practice Address - Country:US
Practice Address - Phone:410-696-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM319106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2199715OtherMAMSC OPTIMUM CHOICE